Hospital Ángeles del Pedregal

Camino a Santa Teresa No. 1055, Consultorio 608 CP 10700, CDMX. Teléfonos: 5568-4081, 5568-2422 y 5652-6346.

Hospital San Ángel Inn Patriotismo Mixcoac

Consultorio 608, Av. Patriotismo, colonia San Juan Alcaldía Benito Juárez, CP 03730, CDMX Teléfonos: 2155-6622 y 4770-4870 ext. 5682

Correo

drcisneros@cirugiadepieytobillo.com.mx

Cirugía de liberación para el síndrome del túnel tarsiano / Surgical Release for Tarsal Tunnel Syndrome

Fuente
Este artículo es originalmente publicado en:
http://nervesurgery.wustl.edu
http://orthopaedicprinciples.com/2011/11/surgical-release-for-tarsal-tunnel-syndrome/

Tarsal tunnel syndrome describes the compression of the tibial nerve through the tarsal tunnel which results in pain and numbness in the plantar aspect of the foot. The tibial nerve has three major branches which include the calcaneal, medial plantar, and lateral plantar nerve branches. There are two primary structures responsible for compression of the tibial nerve: (1) flexor retinaculum and (2) a septum that compartmentalizes the medial and lateral plantar nerves and the overlying fascia of the abductor hallucis muscle. The tarsal tunnel release involves releasing these structures. In this case, the patient had a traumatic injury to the lower leg, which required open reduction and internal fixation. The patient had pain and numbness in the tibial nerve distribution along with Tinel’s sign and positive scratch collapse at the tarsal tunnel.
Details of Surgical Demonstration:
00:45 Incision / Exposure of Proximal Incision
02:30 Identifying and Dividing the Superficial Fascia through Scar Tissue
03:48 Identification of the Posterior Tibial Vessels
04:48 Identifying and Dividing the Flexor Retinaculum Proximally
06:33 Identification of the Tibial Nerve Proper
07:20 Incision / Exposure of Distal Incision
09:07 Identifying and Incising the Tendinous Fascia Superficial to the Abductor Hallucis
09:46 Retracting the Abductor Hallucis and Identifying the Deep Fascia to the Abductor Hallucis
10:16 Dividing the Deep Fascia Superficial to the Lateral Plantar Nerve
11:30 Identifying the Abductor Hallucis Fascia Superficial to the Medial Plantar Nerve
13:29 Dividing the Abductor Hallucis Fascia Superficial to the Medial Plantar Nerve
14:22 Identification and Release of the Calcaneal Nerve Branch
14:50 Identifying and Dividing the Flexor Retinaculum Distally
15:26 Further Division of the Abductor Hallucis Fascia Superficial to the Lateral Plantar Nerve
Narration: Susan E. Mackinnon
Videography: Andrew Yee

Cirugía para la corrección del hallux valgus: resultados mínimos de cinco años con una herramienta de resultado reportado y validado por el paciente y análisis de regresión / Surgery for the correction of hallux valgus: Minimum five-year results with a validated patient-reported outcome tool and regression analysis

Fuente
Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pubmed/25628284?dopt=Abstract
http://www.bjj.boneandjoint.org.uk/content/97-B/2/208.abstract
De:
Chong A1Nazarian N1Chandrananth J1Tacey M2Shepherd D1Tran P1.
 2015 Feb;97-B(2):208-14. doi: 10.1302/0301-620X.97B2.34891.
Todos los derechos reservados para:
Copyright © 2015 THE BRITISH EDITORIAL SOCIETY OF BONE & JOINT SURGERY All Rights Reserved.


Abstract

This study sought to determine the medium-term patient-reported and radiographic outcomes in patients undergoing surgery for hallux valgus. A total of 118 patients (162 feet) underwent surgery for hallux valgus between January 2008 and June 2009. The Manchester-Oxford Foot Questionnaire (MOXFQ), a validated tool for the assessment of outcome after surgery for hallux valgus, was used and patient satisfaction was sought. The medical records and radiographs were reviewed retrospectively. At a mean of 5.2 years (4.7 to 6.0) post-operatively, the median combined MOXFQ score was 7.8 (IQR:0 to 32.8). The median domain scores for pain, walking/standing, and social interaction were 10 (IQR: 0 to 45), 0 (IQR: 0 to 32.1) and 6.3 (IQR: 0 to 25) respectively. A total of 119 procedures (73.9%, in 90 patients) were reported as satisfactory but only 53 feet (32.7%, in 43 patients) were completely asymptomatic. The mean (SD) correction of hallux valgus, intermetatarsal, and distal metatarsal articular angles was 18.5° (8.8°), 5.7° (3.3°), and 16.6° (8.8°), respectively. Multivariable regression analysis identified that an American Association of Anesthesiologists grade of >1 (Incident Rate Ratio (IRR) = 1.67, p-value = 0.011) and recurrent deformity (IRR = 1.77, p-value = 0.003) were associated with significantly worse MOXFQ scores. No correlation was found between the severity of deformity, the type, or degree of surgical correction and the outcome. When using a validated outcome score for the assessment of outcome after surgery for hallux valgus, the long-term results are worse than expected when compared with the short- and mid-term outcomes, with 25.9% of patients dissatisfied at a mean follow-up of 5.2 years. Cite this article: Bone Joint J 2015;97-B:208-14.

Resumen
Este estudio trató de determinar los resultados de los pacientes reportados y radiográficos a medio plazo en pacientes sometidos a cirugía de hallux valgus. Un total de 118 pacientes (162 pies) fue operado de hallux valgus entre enero de 2008 y junio de 2009. El Foot Cuestionario Manchester-Oxford (MOXFQ), una herramienta validada para la evaluación de los resultados después de la cirugía para el hallux valgus, se utilizó y la satisfacción del paciente que se buscaba. Los registros médicos y las radiografías se revisaron retrospectivamente. A una media de 5,2 años (4,7-6,0) después de la operación, la puntuación MOXFQ combinado mediana fue de 7,8 (IQR: 0-32,8). El dominio mediana de las puntuaciones de dolor, caminar / de pie, y la interacción social fueron de 10 (IQR: de 0 a 45), 0 (IQR: 0 a 32.1) y 6,3 (IQR: de 0 a 25), respectivamente.Un total de 119 procedimientos (73,9%, en 90 pacientes) fueron reportados como satisfactorio, pero sólo 53 pies (32,7%, en 43 pacientes) eran completamente asintomático. La media (SD) de corrección del hallux valgus, intermetatarsal y ángulos articulares metatarsiano distal fue de 18,5 ° (8,8 °), 5,7 ° (3,3 °), y el 16,6 ° (8,8 °), respectivamente. El análisis de regresión multivariable identificó que una Asociación Americana de Anestesiólogos grado de> 1 (Tasa de Incidentes Ratio (TIR) ​​= 1,67, p-valor = 0,011) y la deformidad recurrente (TIR = 1,77, p-valor = 0,003) se asociaron con significativamente peor MOXFQ puntajes. No se encontró correlación entre la gravedad de la deformidad, el tipo o grado de corrección quirúrgica y el resultado. Cuando se utiliza una puntuación validada de resultado para la evaluación de los resultados después de la cirugía para el hallux valgus, los resultados a largo plazo son peores de lo esperado, en comparación con los resultados a corto y medio plazo, con un 25,9% de los pacientes insatisfechos a una media de seguimiento de 5,2 años. Citar este artículo: Bone Joint J 2015; 97-B: 208-14.
© 2015 La Sociedad editorial británica de Bone & Joint Surgery.

PALABRAS CLAVE:
Juanete; Hallux Valgus; Manchester-Oxford Cuestionario Pie (MOXFQ); Resultados;Cirugía

©2015 The British Editorial Society of Bone & Joint Surgery.

KEYWORDS:

Bunion; Hallux Valgus; Manchester-Oxford Foot Questionnaire (MOXFQ); Outcomes; Surgery

PMID:

 

25628284

 

[PubMed – in process]