下肢浅腓神经释放 - 标准

                               
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Compression of the superficial peroneal nerve (SPN) is due to the superficial fascial layer that encapsulates the SPN and its distal entrapment point called the transverse crural ligament. These structures are typically the cause for numbness and pain in the territory of the SPN. Release of the SPN involves the longitudinal release of the superficial fascial layer and the transverse crural ligament. A lateral and anterior fasciotomy is also performed both longitudinally and transversely. Care is taken to look for two branches of the SPN and decompress both branches. This release is performed on patients that present with peroneal neuropathy that fail to resolve from conservative management and have symptoms that localize to the territory of the SPN. In this case, the patient presented with a complex history of neuropathic pain in the lower left leg following multiple knee surgeries over a span of many years. During examination, the patient was able to tolerate light touch related to compression-type injury rather than withdrawing from severe pain in keeping with a neurectomy-type injury; thus compression neuropathy and not neuroma injury was suspected. The scratch collapse test with ethyl chloride revealed provocation, first at the common peroneal nerve at the fibular head, then second at the saphenous nerve in the thigh, and then third at the SPN. Her surgical management included the release of these three nerves. This video outlines the surgical technique for releasing the SPN in the lower leg.

Table of Contents (Standard)
00:00 Introduction
00:32 Incision
00:41Superficial Dissection and Exposure
01:14 Identifying the Superficial Fascial Layer
01:27 Identifying the Superficial Peroneal Nerve Deep to the Fascial Layer
02:10 Identifying the Distal Border of the Transverse Crural Ligament
02:24 Reviewing the Cutaneous Branches of the Superficial Peroneal Nerve
02:59 Proximal Exposure of the Superficial Fascial Layer
03:12Identifying the Anterior Fat Landmark in Relation to the Superficial Peroneal Nerve
03:24 Incising the Superficial Fascial Layer to the Fat Landmark
03:42 Incising the Superficial Fascial Layer to the Superficial Peroneal Nerve
05:47 Palpating Proximally and Release the Proximal Superficial Fascial Layer
06:10 Horizontal Release of the Superficial Fascial Layer
07:43 Release of the Distal Superficial Fascia Layer
07:67 Demonstrating the Rigidity of the Transverse Crural Ligament
08:21 Release of the Transverse Crural Ligament
09:21 Additional Horizontal Release of the Superficial Fascial Layer
09:57 Proximal Check for Compressive Fascia through Palpating and Releasing
11:12 Credits