Common peroneal nerve injury, scientific treatment is crucial

Damage to the common peroneal nerve can make people very anxious, because it is related to the health of the human body, so it is particularly important to learn scientific treatment. First of all, people must have a certain understanding of the symptoms of common peroneal nerve injury, make a preliminary assessment of their own situation, and use medication or seek medical treatment in a timely manner so as to restore health as soon as possible.

1. Basic information of the common peroneal nerve

After branching off from the sciatic nerve, it runs obliquely outward and downward along the medial edge of the biceps femoris, passes through the upper and outer part of the popliteal fossa, reaches between the biceps femoris tendon and the lateral head of the gastrocnemius, passes through the deep surface of the peroneus longus muscle, bypasses the fibular neck, and is divided into two terminal branches: the deep peroneal nerve and the superficial peroneal nerve. It innervates the peroneus longus and brevis, tibialis anterior, extensor digitorum longus, extensor digitorum longus, extensor digitorum brevis ... and the skin sensation of the lateral side of the lower leg and dorsum of the foot.

2. Symptoms and Signs

1. Movement: Due to paralysis of the tibialis anterior, extensor longus and brevis, extensor toe longus and brevis, and peroneus longus and brevis of the calf extensor muscles, the affected foot drops and turns inward.

2. Sensation: The sensory branch of the common peroneal nerve is distributed on the lateral side of the calf and the dorsum of the foot, so the sensation in this area is lost.

3. Nutrition The dorsum of the foot is susceptible to trauma, frostbite and burns, which may affect its function.

3. Medication

Pay attention to prevention, such as adding a pad behind the fibular head before applying plaster or splint, and prevent damage to the common peroneal nerve during surgery at the popliteal fossa or fibular head. Common peroneal nerve injury should be treated as early as possible. In most cases, it can be repaired through direct nerve anastomosis. If the nerve defect is too large, autologous sural nerve transplantation can be considered for repair. Clinical treatment shows that surgery within 3 months after injury is most effective. Although closed common peroneal nerve injuries may recover on their own, surgical exploration should be performed as soon as possible to perform release, anastomosis, or nerve transplantation. If there is no recovery, the posterior tibialis muscle can be transferred or a triple arthrodesis can be performed to improve function. Sensory impairment is not in the weight-bearing area and need not be treated.

1. Exposure of the common peroneal nerve

(1) Exposure of the common peroneal nerve in the popliteal fossa: The patient lies prone with the affected limb slightly elevated. The surgical steps are as follows:

① Incision: From about 8 cm above the fibular head at the posterior femoral region, along the inner edge of the biceps femoris, from the lower outside through the back of the fibular head, to the front and lower part of the fibular neck, about 12 cm long. The incision can be extended if necessary.

② Cut the fascia: free the common peroneal nerve deep inside the biceps femoris, gently pull it with a rubber strip, and continue to free it distally to the slightly below the posterior and outer part of the fibular head. If necessary, separate the superficial and deep branches of the common peroneal nerve here.

(2) Exposure of the deep peroneal nerve in the calf: Position: supine. The surgical steps are as follows:

①Incision: Make an incision along the outer edge of the tibialis anterior muscle. The location and length depend on needs.

② Cut the deep fascia along the incision line and separate it between the tibialis anterior muscle and the long extensor muscle to expose the anterior tibial artery. The vein is close to the artery and the deep peroneal nerve is located on the outside of the artery.

2. Transfer of the posterior tibial tendon to correct foot drop deformity. The posterior tibial tendon is transferred to the dorsum of the foot to replace the extensor function. There are two methods: transfer through the tibia and fibula interosseous membrane foramen and transfer through the subcutaneous part of the anterior medial tibia.

The patient lies in the supine position. The surgical steps are as follows:

(1) Make a 2-3 cm long longitudinal incision at the medial edge of the dorsum of the foot at the navicular tubercle to expose and free the posterior tibial tendon and cut it off together with the periosteum close to its insertion point.

(2) Make an S-shaped incision 5 to 6 cm long on the inner side of the lower 1/3 of the calf and behind the posterior edge of the tibia. Cut the skin, subcutaneous tissue, and deep fascia to expose and free the posterior tibial tendon, and then remove the distal end of the tendon through this incision. Be careful not to damage the posterior tibial neurovascular bundle behind the muscle.

(3) Make a 2-3 cm long longitudinal incision in the middle of the dorsum of the foot, corresponding to the lateral cuneiform bone, to expose the cuneiform bone. After peeling off the periosteum, use a hand drill to drill a bone hole toward the sole of the foot.

(4) Make a subcutaneous tunnel between the dorsum incision and the medial calf incision, and pull the posterior tibial tendon to the dorsum incision through the subcutaneous tunnel. At this time, the medial incision on the dorsum of the foot and the medial incision on the calf can be sutured.

(5) The foot is dorsiflexed to 80° and the end of the posterior tibial tendon is sutured and fixed to the bone hole of the lateral cuneiform bone using the wire pull-out method. The tendon should be kept in proper tension during suture fixation. The midline incision on the dorsum of the foot was sutured.

(6) After surgery, the leg is fixed in the above position with a short-leg plaster. After 6 weeks, the plaster and the fixation wire are removed and functional training is started.