Endoscopic Study And Evaluation Of Anatomy Related Tarsal Tunnel Syndrome

Objective: The study include the anatomy and the adjacent of thetarsal tunnel syndrome, the operative approach of soluting the tibialnerve in endoscopy and the significance making use it in operation. Methods: The five cadavers (ten sides) are thawed, and theirlower limbs are layed straight up in the bench, then the ankle arelocalizated in the plant flex posture. medial malleolus arc incision tothe bottom, cut the skin, tissue, careful separation measurement intothe operative approach of endoscopy, and flexor retinaculum,the soleof foot medial and lateral plantar tunnels of the relevant data. (①surveying flexor retinaculum to the length, breadth and thickness ofmedial and lateral plantar tunnels;② medial and lateral plantartunnels diameter nerve related data;③ positioning tool to measure theoperative approach of endoscopy). the operative approach is designedwith the use of 10 (20 side) of the cadavers to ease lower part of legnerve surgery, and cut flexor retinaculum of fibre from medial andlateral plantar tunnels of the middle. (① lower limb ones is in thebench and the ankle are localizated in the plant flex posture;② underthe pilot detected in the specimens of anatomy data entry approachmarking three points;③ since one 80-100ml 0.9% physiologicalsaline infusion into the road point, and made a Tarsal tunnel;④ theuse of probe from the first point of entry into the Road (skin incisionabout 1.0cm) along the lower part of tibial nerve with guns and ridingcross-channel detection of blood vessels, since two-way point insertedhooks, from lower part of tibial nerve with sticks cut flexorretinaculum;⑤ since the three-way point using probe into thethumb-muscle following detection of the outer side of the lower partof tibial nerve fibres between the branches and diaphragm, sincetwo-way hook knife point inserted a fiber diaphragm;⑥ crowding outthe tubes saline, suture skin).Results: The anatomy of the ankle through research,measurement of flexor retinaculum to the ankles of the relevantexperimental data and the medial and lateral plantar tunnels of theanatomy data. medial malleolus with control at the bottom, startingfrom the highest point to calcaneus medial malleolus culmination ofthe center line, downward vertical line and setting, point at the rearcalcaneal tuberosity medial macula. in lateral position of calcaneus,we can see a clear dented that its bottom. Accommodate with the leftnerve, the fibre surface fat deposition by organizations covered. flexorretinaculum is cut in Endoscopy to avoid damage to calcanealbranches. According to the autopsy detectedmedial malleolus vertex,sporting only tendo calcaneusis doing exactly the 4.5cm lower part oftibial nerve and control access to the lower part of tibial after arterialsheath of the ankle position slightly on the lower part of tibial nerve,and to avoid injuries posterior tibial artery. medial malleolus pointedto the mid-point in calcaneus tubercle links to between abductorpollicis and flexor retinaculum to the ankles of the weakest areas, butalso lower part of tibial nerve arc to the cutting line. calcaneustubercle and the first metatarsophalangeal joints line marking themid-point is between abductor pollicis and flexor retinaculum, bypassof the outer side of the branch, no important organizations, smallinjury, and medial malleolus pointed to the mid-point in calcaneustubercle is a network of nerves between the medial and lateral nerve ofthe fibre diaphragm. Therefore, we designed a three-way Operativeapproach to solute the tibial nerve in Endoscopy. The perpendicularbisector which is the medial malleolus pointed to the medial margin oftendo calcaneus insertion is 4.5cm;the midpoint of the medialmalleolus pointed to the calcaneus tubercle;the midpoint of thecalcaneus tubercle to the medial margin of the firstmetatarsophalangeal joints).Conclusions: The tarsal tunnel syndrome of the most commoncauses of disease are ankle injuries. Traditional treatment methods areconservative treatment or surgery the flexor retinaculum is cut, and thetibial nerve is soluted. Surgery may damage the skin sticks, a catalytic,sexual scar pain, blood can not completely serious conglutination,affecting nerve function recovery, and notch resume slower and earlyactivities was limited. Applications endoscopic small incision surgeryand the time is short, alleviate the suffering of the patients can get outof bed early, for the restoration of the disease. Light responseorganizations surgery without tourniquet, bleeding minimal, sheresumed results clearly, avoid surgery bleeding caused by the impactof conglutination surgical results. The treatment of the tarsal tunnelsyndromeis in endoscope is very popular, but the ankle possession ofposterior tibial artery by major line, and a lot of blood vessels branchin the ankles tunnel and blood vessels has not yet appeared before thebranch branches, and riding cross-lower part of leg nerve, is notconducive to the pace of operations. Meanwhile ankle joints of pliantactivities degrees from and elbow pipes (ankle joints buckling andstraight the scope of families were reported, pliant activities about60°-70°, straight activities about 20°, metatarsus Wat activities about40°-50°), the tibial nerve in the ankle of the sliding relatively small,apart from being flexor retinaculum cards pressure, its branches(setting of the outer side nerve, with the left nerve) in setting andcalcaneus Department can produce cards pressure, double cardspressure. The blocked pot can not be completely removed using Chowtwo point method, and the tibial nerve can not be completely soluted.This test through five cases (10 side) of the lower limb fresh adultbody autopsy studies detected flexor retinaculum and within medialand lateral plantar tunnels of the relevant data, we found ourselves thedifference from tarsal tunnel syndrome to carpal canal and elbowpipes, using two law can not completely solute the tibial nerve.According to autopsy we detected the tibial nerve of the walk in theankle is about 140°, and endoscope microinstrument is straight, inorder to complete solute the tibial nerve, we use three-way approachto address the issues involved. Along the tibial nerve after sufferingnerve left after the first found in the tibial nerve with sticks, and thenuse a hook knife to flexor retinaculumto avoid damage to calcanealbranches. For the higher of the location of the outer side branches candirectly use one and two-way point between the fiber diaphragm beendirectly. When using endoscopic to cut flexor retinaculum, attentionshould be given to avoid toinjury the calcaneal branches.