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1.
Article in Chinese | WPRIM | ID: wpr-1021485

ABSTRACT

BACKGROUND:Peripheral nerves play an important role in bone metabolism.In clinical practice,the specific impact of nerve injury on bone transport technology needs further study. OBJECTIVE:To investigate the effect of tibial nerve injury on the treatment of tibial slip by single-plane osteotomy. METHODS:Thirty-two patients with tibial bone defects admitted to Tangshan Second Hospital from May 2011 to June 2022 were selected.According to the presence or absence of tibial nerve injury,patients were divided into the tibial nerve injury group(n=16)and the non-tibial nerve injury group(n=16).Both groups were treated with single-plane osteotomy and bone slip.After treatment,the patients were followed up to collect the mineralization zone healing index,external fixation index,docking point healing and needle infection.After the removal of external fixation,the bone healing and functional evaluation were evaluated by a classification of the Association for the Study and Application of the Method of Ilizarov(ASAMI). RESULTS AND CONCLUSION:(1)All 32 patients were followed up for(25.28±4.79)months.There were no significant differences in bone healing time,external fixation time,healing index and external fixation index between the two groups(P>0.05).Needle infection occurred in two cases of the tibial nerve injury group and one case of the non-tibial nerve injury group,all of which were PALEY I,and there was no significant difference between the two groups(P>0.05).The non-union rate of the occlusal end of the tibial nerve injury group was 31%,and that of the non-tibial nerve injury group was 13%;there was no statistical difference between the two groups(P>0.05).The excellent and good rate of ASAMI bone healing score in the two groups was 100%;the excellent and good rate of limb score was 81%in the tibial nerve injury group and 94%in the non-tibial nerve injury group;there was no statistical difference between the two groups(P>0.05).(2)Our research shows that tibial nerve injury has no significant effect on the mineralization speed,external fixation time,union of the occlusal end,infection of the needle tract,and the quality of bone formation in the mineralized area of the single-plane osteotomy.

2.
Neuroscience Bulletin ; (6): 177-193, 2023.
Article in English | WPRIM | ID: wpr-971543

ABSTRACT

Post-amputation pain causes great suffering to amputees, but still no effective drugs are available due to its elusive mechanisms. Our previous clinical studies found that surgical removal or radiofrequency treatment of the neuroma at the axotomized nerve stump effectively relieves the phantom pain afflicting patients after amputation. This indicated an essential role of the residual nerve stump in the formation of chronic post-amputation pain (CPAP). However, the molecular mechanism by which the residual nerve stump or neuroma is involved and regulates CPAP is still a mystery. In this study, we found that nociceptors expressed the mechanosensitive ion channel TMEM63A and macrophages infiltrated into the dorsal root ganglion (DRG) neurons worked synergistically to promote CPAP. Histology and qRT-PCR showed that TMEM63A was mainly expressed in mechanical pain-producing non-peptidergic nociceptors in the DRG, and the expression of TMEM63A increased significantly both in the neuroma from amputated patients and the DRG in a mouse model of tibial nerve transfer (TNT). Behavioral tests showed that the mechanical, heat, and cold sensitivity were not affected in the Tmem63a-/- mice in the naïve state, suggesting the basal pain was not affected. In the inflammatory and post-amputation state, the mechanical allodynia but not the heat hyperalgesia or cold allodynia was significantly decreased in Tmem63a-/- mice. Further study showed that there was severe neuronal injury and macrophage infiltration in the DRG, tibial nerve, residual stump, and the neuroma-like structure of the TNT mouse model, Consistent with this, expression of the pro-inflammatory cytokines TNF-α, IL-6, and IL-1β all increased dramatically in the DRG. Interestingly, the deletion of Tmem63a significantly reduced the macrophage infiltration in the DRG but not in the tibial nerve stump. Furthermore, the ablation of macrophages significantly reduced both the expression of Tmem63a and the mechanical allodynia in the TNT mouse model, indicating an interaction between nociceptors and macrophages, and that these two factors gang up together to regulate the formation of CPAP. This provides a new insight into the mechanisms underlying CPAP and potential drug targets its treatment.


Subject(s)
Animals , Mice , Amputation, Surgical , Chronic Pain/pathology , Disease Models, Animal , Ganglia, Spinal/pathology , Hyperalgesia/etiology , Ion Channels/metabolism , Macrophages , Neuroma/pathology
3.
Article in Chinese | WPRIM | ID: wpr-1024203

ABSTRACT

Objective:To investigate the efficacy of tibial nerve block achieved through different approaches combined with patient-controlled intravenous analgesia for surgical treatment of calcaneus fractures.Methods:This is a case-control study. A total of 80 patients scheduled for calcaneus surgeries at Guangxi Orthopedic Hospital from January to December 2022 were randomly assigned to undergo either a tibial nerve combined with medial sural nerve block on the upper leg (T1 group, n = 40) or a tibial nerve block on the popliteal fossa (T2 group, n = 40). All nerve blocks were performed under ultrasound guidance. Following surgery, the same medication was used to set up the intravenous infusion pump. At 6, 12, 24, and 48 hours post-surgery, the Visual Analogue Scale scores were recorded. At 1 and 2 days post-surgery, the Pittsburgh Sleep Quality Index scores and the duration of postoperative sensory and motor nerve blocks were documented. The need for postoperative pain relief medication and the occurrence of nausea and vomiting were also recorded. Patient satisfaction with postoperative analgesia was assessed. Results:There was no significant difference in Visual Analogue Scale scores between the two groups at different time points after surgery (all P > 0.05), and there was no significant difference in Pittsburgh Sleep Quality Index scores between the two groups after surgery ( P > 0.05). The duration of postoperative sensory and motor nerve block in the T1 group were (20.98 ± 2.06) hours and (18.88 ± 2.31) hours, respectively, which were significantly shorter than (22.75 ± 1.71) hours and (20.78 ± 1.95) hours in the T2 group ( t = -4.20, -3.97, both P < 0.001). There was no significant difference in patient satisfaction with postoperative analgesia between the two groups ( P > 0.05). Conclusion:Two different approaches of tibial nerve block combined with an intravenous analgesia pump can provide satisfactory analgesic effects after surgical treatment of calcaneus fractures. Ultrasound-guided tibial nerve block combined with medial sural nerve block can more quickly restore postoperative limb motor function than tibial nerve block on the popliteal fossa.

4.
Chinese Journal of Urology ; (12): 212-216, 2022.
Article in Chinese | WPRIM | ID: wpr-933195

ABSTRACT

Objective:To systematically review the efficacy and safety of electrostimulation of the posterior tibial nerve and antimuscarinic drugs in the treatment of overactive bladder.Methods:The literature search was conducted using the PubMed, The Cochrane Library, EMbase, Medline, CNKI, CQVIP, Wanfang databases.The retrieval period was from the establishment of the database to February 2021. Literature was screened and evaluated independently by two investigators to compare the safety and efficacy of electrostimulation of the posterior tibial nerve and antimuscarinic drugs in the treatment of overactive bladder. Meta-analysis was performed using Review Manager 5.4 software.Results:A total of 11 clinical trials, including 10 randomized controlled trials and 1 cross-over study were included, involving 605 patients, including 309 in the experimental group (nerve stimulation group) and 296 in the control group(antimuscarinic drugs group). The results of meta-analysis showed as follow. For patients with non-neurogenetic overactive bladder, there was no statistically significant differences between electrostimulation of the posterior tibial nerve therapy and antimuscarinic drugs in the improvement of 24h urination frequency( MD=-0.06, 95% CI -1.67-1.54, P>0.05), 24h urge incontinence frequency( MD=0.04, 95% CI -0.46-0.54, P>0.05), symptoms scores of OAB-q questionnaire( MD=0.37, 95% CI -0.02-0.76, P>0.05)and quality of life scores( SMD=0.32, 95% CI-0.06-0.69, P>0.05). However, compared with antimuscarinic drugs, posterior tibial nerve stimulation had better efficacy satisfaction rate ( OR=1.97, 95% CI 1.16-3.36, P<0.05) and lower side effect rate ( OR=0.24, 95% CI 0.12-0.48, P<0.0001). And the results have significant statistical differences. Conclusions:Electrostimulation of the posterior tibial nerve was almost as effective as antimuscarinic drugs in improving symptoms and quality of life in patients with non-neurogenic OAB. However, compared with antimuscarinic drugs, electrostimulation of the posterior tibial nerve had a higher efficacy satisfaction rate and a lower incidence of side effects. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

5.
Article in Chinese | WPRIM | ID: wpr-939984

ABSTRACT

ObjectiveTo observe the inhibitory effects of a novel wearable transcutaneous tibial nerve stimulator on bladder reflex in cats under different stimulation parameters. MethodsA total of 18 cats were divided into intensities, frequencies and waveforms groups, which wore the stimulator on the ankles and stimulated in different threshold (T) intensities (1/2 T, 1 T, 3/2 T and 2 T), frequencies (5 Hz, 10 Hz, 15 Hz and 30 Hz) and waveforms (A and B). The cats were anesthetized and infused normal saline to induce bladder reflex, while the bladder capacity was measured. Cystometrograms were compared among stimulation parameters. ResultsThe bladder capacity was not significantly different among the intensities (F = 1.997, P = 0.126), while the bladder capacity was more after TNS of 3/2 T and 2 T than baseline (P < 0.05). The bladder capacity was significantly different among the frequencies (F = 3.894, P = 0.014), while the bladder capacity was more after 5 Hz, 10 Hz and 15 Hz of TNS (P < 0.05). The bladder capacity was significantly different between the waveforms (F = 5.184, P = 0.019), while the bladder capacity was more after waveform A of TNS than baseline (P < 0.05). ConclusionThe novel wearable transcutaneous tibial nerve stimulator can effectively inhibit the physiological bladder reflex in cats, which associates to the intensity, frequency and waveform of stimulation.

6.
Arq. bras. neurocir ; 41(2): 145-152, 2022.
Article in English | LILACS-Express | LILACS | ID: biblio-1567978

ABSTRACT

Introduction Tarsal tunnel syndrome (TTS) is caused by compression of the posterior tibial nerve. Objective To evaluate the effectiveness of surgical treatments compared to conser vative treatments in reducing the symptoms of the syndrome. Methods The PubMed, Lilacs, Cochrane Library, and PEDro databases were used for this review. Results Only 11 articles were selected. Conclusion The most common causes of TTS identified were presence of ganglia, bone prominence causing a talocalcaneal collision, trauma, varicose and idiopathic veins. The main symptom was pain in the medial plantar region and paresthesia that can radiate to the fingers or to the calf. Most patients have a positive Tinel sign upon physical examination. Electrodiagnostic test usually shows the presence of latency in sensory nerve conduction. There is no consensus suggesting that a longer time between diagnosis and surgical treatment leads to worse prognosis. In the group of operated patients, the ones who benefited most from the procedure were those who had a structure such as ganglion, cysts, or varicosities causing compression. The most cited surgical complications were postsurgical wound infection, wound dehiscence, and calcaneus hypoesthesia. Regarding surgical techniques, the release of the posterior tibial nerve via endoscopy had a favorable outcome in relation to the symptoms of pain and hypoesthesia, with no reports of infection of the operative site in the articles identified in this review. We observed a rate of good or excellent pain control of 68% (n » 204) for open surgery (n » 299), 100% (n » 8) for endoscopic surgery (n » 8), and 7% (n » 2) for conservative treatment (n » 28).


Introdução A síndrome do túnel do tarso (STT) é causada pela compressão do nervo tibial posterior. Objetivo Avaliar a eficácia dos tratamentos cirúrgicos em comparação aos conservadores na redução dos sintomas da síndrome. Métodos Foram utilizados as bases de dados PubMed, Lilacs, Cochrane Library e PEDro. Resultados Apenas 11 artigos foram selecionados. Conclusão As causas mais comuns de STT identificadas foram presença de gânglios, proeminência óssea causando colisão talocalcânea, trauma, varizes e veias. O principal sintoma foi dor na região plantar medial e parestesia, que pode irradiar para os dedos ou panturrilha. A grande maioria dos pacientes apresenta um sinal de Tinel positivo no exame físico. O teste eletrodiagnóstico geralmente mostra a presença de latência na condução nervosa sensorial. Não há consenso de que o maior tempo entre o diagnóstico e o tratamento cirúrgico leva a um pior prognóstico. No grupo de pacientes operados, os que mais se beneficiaram com o procedimento foram aqueles que apresentavam estrutura como gânglio, cistos ou varicosidades causando compressão. As complicações cirúrgicas mais citadas foram infecção da ferida operatória, deiscência da ferida e hipoestesia do calcâneo. A cirurgia endoscópica teve evolução favorável em relação aos sintomas de dor e hipoestesia, não havendo relato de infecção do sítio operatório. Observou-se que a taxa de bom ou excelente controle da dor foi de 68% (n » 204) para cirurgia aberta (n » 299), 100% (n » 8) para cirurgia endoscópica (n » 8), e 7% (n » 2) para o tratamento conservador (n » 28).

7.
Clinics ; 76: e3039, 2021. tab, graf
Article in English | LILACS | ID: biblio-1286090

ABSTRACT

OBJECTIVE: To compare the effectiveness of tibial nerve transcutaneous electrical nerve stimulation (TENS) for an overactive bladder, considering the sites of application and frequency of attendance. METHODS: This multi-arm randomized controlled trial enrolled 137 adult women (61.0±9.0 years) with overactive bladder from a university hospital. They underwent 12 sessions of 30-min TENS application and were assigned to five groups: one leg, once a week (n=26); one leg, twice a week (n=27); two legs, once a week (n=26); two legs, twice a week (n=28); and placebo (n=30). Symptoms of overactive bladder and its impact on quality of life were evaluated before and after 6 or 12 weeks of treatment using the Overactive Bladder Questionnaire-V8 and voiding diary. ClinicalTrials.gov: NCT01912885. RESULTS: The use of one leg, once a week TENS application reduced the frequency of urgency episodes compared with the placebo (1.0±1.6 vs. 1.4±1.9; p=0.046) and frequency of incontinence episodes compared with the placebo (0.7±1.4 vs.1.4±2.2; p<0.0001). The one-leg, twice a week protocol decreased the urinary frequency compared with the two legs, once a week protocol (8.2±3.5 vs. 9.0±5.1; p=0.026) and placebo (8.2±3.5 vs. 7.9±2.7; p=0.02). Nocturia improved using the two legs, once a week protocol (1.5±1.8) when compared with the one leg, twice a week protocol (1.9±2.0) and placebo (1.7±1.6) (p=0.005 and p=0.027, respectively). Nocturia also improved using the two legs, twice a week protocol when compared with the one leg, twice a week protocol (1.3±1.2 vs.1.9±2.0; p=0.011). CONCLUSION: One-leg stimulation improved the daily urinary frequency, urgency, and incontinence, and the two-leg stimulation once and twice weekly improved nocturia.


Subject(s)
Humans , Female , Adult , Urinary Incontinence , Transcutaneous Electric Nerve Stimulation , Urinary Bladder, Overactive/therapy , Quality of Life , Tibial Nerve , Treatment Outcome
8.
Ginecol. obstet. Méx ; 89(12): 985-993, ene. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1375564

ABSTRACT

Resumen OBJETIVO: Reportar dos casos de pacientes con el efecto de la estimulación del nervio tibial posterior en la retención urinaria posparto. CASOS CLÍNICOS: Caso 1: Paciente de 41 años, con dos cesáreas previas, sobrepeso (IMC 28 kg/m2), con 33 semanas de embarazo, hipertensión arterial crónica y preeclampsia sobreagregada asociada con datos de déficit neurológico. En el puerperio tardío tuvo dificultad para miccionar y dolor suprapúbico. Con base en la urodinamia se diagnosticó: disinergia detrusor-esfínter y se trató con estimulación del nervio tibial posterior durante 20 minutos cada semana con duración de fase de 200 µs y frecuencias de 10 Hz durante 12 sesiones. Los parámetros urodinámicos mejoraron y se restablecieron las micciones espontáneas, se redujo la frecuencia del cateterismo limpio intermitente y el efecto continuó a 31 meses de seguimiento. Caso 2: Paciente de 38 años, primigesta, IMC 21 kg/m2 , con antecedente de hipotiroidismo subclínico. A los cinco días de puerperio tuvo retención urinaria de 2000 mL; se le colocó una sonda Foley a drenaje contínuo y, posteriormente, un tapón con vaciado cada 2 horas. No obstante lo anterior tuvo nuevos episodios de retención urinaria que ameritaron el inicio del cateterismo limpio intermitente, 5 en 24 horas y estimulación del nervio tibial posterior con corriente bifásica asimétrica. Se consiguió una mejoría subjetiva del 100% y cambios urodinámicos. Las micciones espontáneas se reiniciaron sin requerir cateterismo limpio intermitente, fue dada de alta luego de un año de seguimiento. CONCLUSIÓN: De acuerdo con los desenlaces del estudio, la estimulación del nervio tibial posterior podría ofrecer una alternativa de tratamiento prometedora en pacientes con retención urinaria posparto.


Abstract OBJECTIVE: Case report of the effect of posterior tibial nerve stimulation on postpartum urinary retention. CASE REPORT: Case 1: 41-year-old patient, with two previous cesarean sections, overweight (BMI 28 kg/m2), 33 weeks of pregnancy, chronic arterial hypertension and over-aggregated preeclampsia associated with data of neurological deficit. In the late puerperium she had difficulty urinating and suprapubic pain. Based on urodynamics, detrusor-sphincter dyssynergia was diagnosed and she was treated with posterior tibial nerve stimulation for 20 minutes every week with phase duration 200 µs and frequency 10 Hz during 12 sessions. Urodynamic parameters improved and spontaneous micturition was restored, the frequency of intermittent clean catheterization was reduced, and the effect continued at 31 months follow-up. Case 2: 38-year-old primigravida patient, BMI 21 kg/m2, with a history of subclinical hypothyroidism. Five days postpartum she had urinary retention of 2000 mL; a Foley catheter was placed for continuous drainage and, subsequently, a plug with emptying every 2 hours. Notwithstanding the above, she had new episodes of urinary retention that warranted the initiation of intermittent clean catheterization, 5 in 24 hours and stimulation of the posterior tibial nerve with asymmetric biphasic current, she had a subjective improvement of 100% and urodynamic changes. Spontaneous urination resumed without requiring intermittent clean catheterization, she was discharged after one year of follow-up. CONCLUSION: According to the study outcomes, posterior tibial nerve stimulation could offer a promising treatment alternative in patients with postpartum urinary retention.

9.
Article | IMSEAR | ID: sea-212055

ABSTRACT

The sciatic nerve has a long course right from the pelvis to the apex of the popliteal fossa. The point of division of the sciatic nerve into tibial and common peroneal nerves is very variable. The variation in the division of the sciatic nerve described in the present study should be helpful for anaesthetists and orthopaedic surgeons. While doing the dissection and teaching of the gluteal region in the Post Graduate Department of Anatomy, government medical college, Jammu, it was found that on the left side tibial nerve and common peroneal nerve were present instead of sciatic nerve. It meant that the main nerve that is the sciatic nerve had already been divided into its terminal branches in the pelvis region. Both tibial and common peroneal nerve were seen coming out of the pelvis below the piriformis muscle, while on the right side there were no variation. The sciatic nerve was seen coming out of the pelvis below the piriformis muscle as usual. Because of this high division of the sciatic nerve in the pelvis, there are many complications like failed sciatic nerve block during anaesthesia while performing surgery, but high division of the sciatic nerve may result in escape of either tibial nerve or common peroneal nerve. The gluteal region, back of the thigh and leg of the lower limb were dissected to study further course of tibial nerve and the common peroneal nerve. Photographs were also taken.

10.
Article | IMSEAR | ID: sea-198697

ABSTRACT

Background: Variations in the level of terminal branching of tibial nerve into medial and lateral plantar nerve inthe posterior tarsal tunnel and its relations with posterior tibial artery has tremendous clinical importance.Tibial nerve and its terminal branches are at risk of entrapment in the posterior tarsal tunnel which is called astarsal tunnel syndrome. The results of surgeries for tarsal tunnel syndrome are variable or suboptimal. Thereason could be poor understanding of detailed anatomy of the tarsal tunnel and potential sites of nervecompression. Information regarding the same can help in endoscopic decompression surgeries for tarsal tunnelsyndrome with minimal exposure of the region to be operated. Knowledge regarding these variations can alsohelp the anesthetists to give ultrasonography guided ankle block without puncturing the blood vessels.Materials and Methods: The authors have studied topographic anatomy of tibial nerve and its terminal branchesin relation with posterior tarsal tunnel in 50 formalinized cadaveric feet. Authors divided the location of divisionof tibial nerve in posterior tarsal tunnel (PTT) into seven levels and also categorized the distance between thepoint of terminal division of tibial nerve (TN) and point of terminal division of posterior tibial artery (PTA) in fourcategories.Results and conclusion: Tibial nerve divides relatively higher than the posterior tibial artery in the PTT. Both lie inthe same compartment in the tarsal tunnel. The tibial nerve is situated deep to posterior tibial blood vessels .Theneurovascular bundle is covered by an unyielding fibrous tissue which could be the reason for the entrapment.Commonest division level of tibial nerve in PTT is level 4 which means the division lies in the range of 6mm to10mm above the distal border of flexor retinaculum. In 52% of feet the distance between point of division of TNand point of division of PTA is in a range between 0-5mm above the distal border of flexor retinaculum fallingunder category 1.

11.
Article | IMSEAR | ID: sea-198561

ABSTRACT

Background: The sciatic nerve arises within the pelvis from the sacral plexus, enters into the gluteal regionthrough the greater sciatic notch and divides into two terminal branches at variable level in the posteriorcompartment of thigh. The variable level of division of sciatic nerve in the thigh leads to failure of sciatic nerveblockage. Considering this clinical problem, the present study has been undertaken with the object to measurethe distance of division of sciatic nerve from the popliteal crease.Materials and Methods: 32 embalmed formalin fixed cadavers were dissected in the gluteal region, back of thighand popliteal fossa and the sciatic nerve were exposed and the distance of division of sciatic nerve weremeasured from the popliteal crease.Results: Out of 32 cadavers dissected the sciatic nerve divides at a distance range of 5 cm–20 cm in malecadavers and 4 cm–11 cm in female cadavers. In 2 cadavers the sciatic nerve divides within the pelvis itself.Conclusion: So, to achieve complete blockage of sciatic nerve in most of the patients the needle should be insertedabout 14 cm (mean distance) above the popliteal crease in males and 8 cm (mean distance) above the poplitealcrease in females

12.
Article | IMSEAR | ID: sea-211143

ABSTRACT

Background: Having prior anatomical knowledge of the anatomical variations is a must for the accurate and effective diagnosis of clinical conditions associated with the sciatic nerve. Sciatic nerve, the longest nerve in the human body has been of great interest for the clinicians and anatomists; though many studies have been conducted in the past to study its anatomical aspect. Till now high division or low formation of the sciatic nerve has been reported but this article highlights the non-union of the components of the sciatic nerve and its clinical outcomes. It had been observed that the common fibular and tibial nerve which arise separately from the sacral plexus remain separated throughout their course. They do not join to form the sciatic nerve. Non-union of the components can result in incomplete blockade of the nerve but selective blockade of one of the components can be done when needed. Aim of the study was to determine the level of formation and the level of division of the sciatic nerve.Methods: Sixty-two lower limbs were taken from the Department of Anatomy, AIIMS, New Delhi and gluteal region was observed for common fibular and tibial nerve and their joining to form the sciatic nerve.Results: Out of 62 lower limbs; 52 specimens showed formation within the pelvis but in 10 specimens the sciatic nerve did not form at any point. Division of the nerve in 52 specimens were at various levels on the posterior aspect of thigh.Conclusions: While giving anaesthesia it’s important to know the formation as well as division of the nerve for an effective lower limb block for various surgical interventions and in case of non union of tibial and common fibular nerve to form the sciatic nerve individual nerve block can be given.

13.
Article | IMSEAR | ID: sea-183704

ABSTRACT

Introduction:The sciatic nerve emerges through the greater sciatic foramen, leaves pelvis and enters into gluteal region by passing below piriformis as a single nerve encompassed by a single epineural sheath. It descends along back of thigh and divides into tibial nerve and common peroneal nerve, usually at superior angle of popliteal fossa. Understanding of variations in the levels of division of sciatic nerve is important for the management of non- discogenic sciatica, posterior hip operations, failed sciatic nerve block. Objective: To study the variations in division of sciatic nerve and to define the level of its exit.Subjects and Methods:Seventeen cadavers (34 limbs) fixed in formalin were dissected and studied during routine dissection in department of Anatomy, Mysore Medical College and level of division of sciatic nerve were noted.Results:Out of 34 limbs, 5 cases (14.7%) were dividing at gluteal region, 2 cases (5.8%) at mid-thigh and 27 cases (79.4%) exited pelvis as a whole nerve and divided at superior angle of popliteal fossa. Type G was most common variation.Conclusion:The exit and level of division of sciatic nerve is important for surgeons as there is surgical maneuvering in this region during posterior hip operations and to avoid iatrogenic nerve injury during deep intramuscular injections in gluteal region.

14.
Article in English | WPRIM | ID: wpr-785853

ABSTRACT

PURPOSE: To evaluate the outcomes of sacral neuromodulation (SNM) after failure of transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with overactive bladder (OAB).METHODS: A retrospective study was conducted in 3 university hospitals and included all patients with OAB and treated with SNM after TPTNS had been tried between October 2008 and May 2018. The primary endpoint was the proportion of definitive SNM device implantation in patients with 50% objective and/or subjective improvement after a test period (stage 1). The secondary outcomes of interest were changes of the number of diurnal voids and nocturia episodes per 24 hours between the end of TPTNS and the end of stage 1.RESULTS: Overall, 28 of the 43 patients included achieved at least 50% objective and/or subjective improvement during stage 1 and underwent an Interstim II implantation (65.1%). The mean daytime frequency decreased significantly from 10.3/day at the end of TPTNS to 7.8 diurnal voids/day at the end of SNM stage 1 (P=0.01). The mean number of nocturia episodes decreased from 2.5/night at the end of TPTNS to 2.1/night at the end of stage 1, but this did not reach statistical significance (P=0.18). There was no other parameter significantly associated with response to SNMCONCLUSIONS: SNM might improve OAB symptoms in most patients who experienced no or poor efficacy with TPTNS. History of failed TPTNS should not preclude the use of SNM in OAB patients.


Subject(s)
Humans , Hospitals, University , Nocturia , Retrospective Studies , Tibial Nerve , Urinary Bladder, Overactive
15.
Article in English | WPRIM | ID: wpr-759563

ABSTRACT

BACKGROUND: This study aimed to determine the optimal location of local anesthetic injection in the interspace between the popliteal artery and posterior capsule of the knee (iPACK), using the anatomical pattern of the articular branch of tibial nerve (ABTN). We hypothesized that injection at the level of ABTN forming a popliteal plexus would mainly spread throughout the popliteal fossa without contacting the tibial or peroneal nerves. METHODS: The anatomical study included 30 soft cadavers. Ultrasound-guided dye injection was performed in legs of 10 cadavers after identifying the position of the ABTN and surrounding structures, followed by dissection to assess its spread. Clinical study was conducted in 15 patients undergoing total knee arthroplasty (TKA) with ultrasound-guided injection in the iPACK. All patients also received continuous adductor canal block. Sensorimotor function of the tibial and common peroneal nerves was determined. RESULTS: In the distal portion of the popliteal fossa, the tibial nerve and popliteal vessels ran superficially and closely together. The trajectory of ABTN ran lateral to the popliteal vasculature, forming a plexus towards the posterior capsule of the knee below the medial side of the upper edge of lateral femoral condyle. In cadavers, the ABTN and surrounding area of the popliteal plexus were stained with dye after injection. In the clinical study, no patients experienced complete motor or sensory blocks. CONCLUSIONS: We described a modified iPACK technique injection at the level of the ABTN forming the popliteal plexus, and it may constitute an optional anesthetic regimen to promote early ambulation following TKA.


Subject(s)
Humans , Arthroplasty, Replacement, Knee , Cadaver , Clinical Study , Early Ambulation , Knee , Leg , Pain, Postoperative , Peroneal Nerve , Popliteal Artery , Tibial Nerve
16.
Anatomy & Cell Biology ; : 87-89, 2019.
Article in English | WPRIM | ID: wpr-738809

ABSTRACT

The medial and lateral plantar nerves are branched from the tibial nerve and move to the tip of the toes. A variation of medial plantar nerve was found on the left side of a 78-year-old Korean male cadaver. The tibial nerve was divided into the lateral and medial plantar nerves beneath the plantar flexor. The medial plantar nerve passed deep to plantar aponeurosis and superficial to the flexor digitorum brevis. It gave off a common plantar digital nerve and then divided into three proper plantar digital nerves near the metatarsal bases. In this article, we report a superficial course of the medial plantar nerve and describe its unique morphology and discuss the clinical significance of this variation.


Subject(s)
Aged , Humans , Male , Cadaver , Metatarsal Bones , Tibial Nerve , Toes
17.
Article in Chinese | WPRIM | ID: wpr-801480

ABSTRACT

Objective@#To evaluate the clinical efficacy of percutaneous tibial nerve electrical stimulation in the treatment of chronic pelvic pain syndrome.@*Methods@#The clinical data of 28 patients with chronic pelvic pain syndrome from January to November 2018 in Dalian Third People′s Hospital were retrospectively analyzed. The patients were treated with percutaneous tibial nerve stimulation. The number of urination in 24 h, number of nocturnal urination, urine volume per urination, quality of life (QOL) score and digital pain intensity score before treatment and after treatment were compared; the patients were followed up for 3 months, and the recurrence and adverse reaction were observed.@*Results@#Compared with those before treatment, the number of urination in 24 h and number of nocturnal urination after treatment were significantly lower: (11.6 ± 6.4) times vs. (20.6 ± 7.8) times and (2.5 ± 1.2) times vs. (5.2 ± 2.6) times, and the urine volume per urination increased significantly: (181.2 ± 65.6) ml vs. (125.4 ± 58.2) ml, the QOL score and digital pain intensity score decreased significantly: (2.6 ± 1.4) scores vs. (5.1 ± 0.8) scores and (2.9 ± 1.3) scores vs. (6.9 ± 1.4) scores, and there were statistical differences (P<0.05). During the follow-up period, none of the patients had recurrent symptoms and obvious adverse reaction.@*Conclusions@#Percutaneous tibial nerve stimulation is an effective way to treat chronic pelvic pain syndrome.

18.
Fisioter. Bras ; 19(5): 723-730, Dez 25, 2018.
Article in Portuguese | LILACS | ID: biblio-1280987

ABSTRACT

Parkinson é uma doença de sintomas motores e não motores, podendo incluir neste último, a bexiga neurogênica, que se caracteriza por sintomas de urgência, com ou sem urge-incontinência, normalmente acompanhada de polaciúria e noctúria. Objetivo: Analisar a eletroestimulação transcutânea e a percutânea do nervo tibial para tratamento da bexiga hiperativa em Parkinsonianos. Metodologia: Foram incluí­dos todos os artigos que mencionaram o tratamento da bexiga hiperativa, com eletroestimulação transcutânea e percutânea do tibial posterior, em pacientes com Parkinson. Realizou-se a busca de março a novembro de 2017, nas bases de dados US National Library of Medicine (MEDLINE), Scientific Eletronic Library Online (SciELO), Physiotherapy Evidence Database (PEDro), Biblioteca Virtual em Saúde (BVS) e Google acadêmico, sem limites de data. Foram utilizados como descritores contidos nos Descritores em Ciências da Saúde (DeCS) as palavras-tí­tulo: bexiga hiperativa, Parkinson e eletroestimulação transcutânea e percutânea do tibial posterior. Foram utilizados como descritores contidos no Medical Subject Headings (MeSH) as palavras-tí­tulo: overactivity bladder, Parkinson"™s disease, electrical stimulation transcutaneous, percutaneous electrical stimulation. Resultados: Dos 8 artigos recuperados, 1 estava duplicado e 2 foram excluí­dos por não estarem disponí­veis, restando cinco artigos: 2 ECRs, 2 experimentais e 1 estudo piloto. Conclusão: a terapia de eletroestimulação tibial, tanto transcutânea, quanto percutânea, se mostra benéfica para tratamento da bexiga hiperativa, em pacientes com Parkinson, porém, se faz necessário a realização de novos estudos, principalmente os de intervenção, para padronização do método. (AU)


Parkinson's disease is a disease of motor and non-motor symptoms, and may include neurogenic bladder, which is characterized by urgency symptoms, with or without urge incontinence. Objective: To analyze the transcutaneous and percutaneous electrostimulation of the tibial nerve for treatment of overactive bladder in Parkinsonians. Methodology: All articles mentioning the treatment of overactive bladder, with transcutaneous and percutaneous electrostimulation of the posterior tibial, were included in patients with Parkinson's disease. The search was carried out from March to November 2017, in the databases National Library of Medicine (Medline), Scientific Electronic Library Online (SciELO), Physiotherapy Evidence Database (PEDro), Virtual Health Library (VHL) and Google academic, without date limits. The descriptors included were: hyperactive bladder, Parkinson's and transcutaneous and percutaneous electrostimulation of the posterior tibial. The descriptors included in the Medical Subject Headings (MeSH) were: overactivity bladder, Parkinson's disease, electrical stimulation transcutaneous, percutaneous electrical stimulation. Results: Of the 8 articles retrieved, 1 was duplicated and 2 were excluded because they were not available, leaving five articles: 2 RCTs, 2 experimental and 1 pilot study. Conclusion: Transcutaneous and percutaneous tibial electrostimulation therapy is beneficial for the treatment of overactive bladder in patients with Parkinson disease. However, it is necessary to carry out new studies, especially interventional ones, to standardize the method. (AU)


Subject(s)
Humans , Tibial Nerve , Transcutaneous Electric Nerve Stimulation , Electric Stimulation , Urinary Bladder, Overactive , Parkinson Disease , Urinary Bladder, Neurogenic
19.
Rev. Pesqui. Fisioter ; 8(3): 430-436, ago., 2018. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-916122

ABSTRACT

INTRODUÇÃO: A bexiga hiperativa é uma condição que tem como principal causa a hiperatividade do músculo detrusor e que afeta muitas mulheres. Tem origem idiopática quando não está vinculada a outra patologia. Em contrapartida, quando possui origem neurogênica, tem como causas alterações neurológicas associadas ao mecanismo da micção. Os tratamentos utilizados para a bexiga hiperativa são medicamentoso, fisioterapia e terapia comportamental. Um dos métodos utilizados na fisioterapia é a eletroestimulação do nervo tibial posterior (PTNS), cujo objetivo é impossibilitar a contração involuntária do músculo detrusor de forma exacerbada. OBJETIVO: Identificar o efeito do uso da eletroestimulação percutânea no nervo tibial posterior como forma de tratamento em mulheres com diagnóstico de bexiga hiperativa associada à perda urinária. MATERIAIS E MÉTODOS: Uma revisão sistemática de literatura, que utilizou artigos de ensaios clínicos randomizados encontrados na base de dados Cochrane. A busca dos artigos foi realizada por dois revisores no período compreendido entre agosto e outubro de 2017, realizada de seguinte forma (Urinary Bladder, Overactive AND Tibial nerve AND Transcutaneous Electric Nerve Stimulation). RESULTADOS: Foram encontrados 17 artigos; destes, 4 foram selecionados. As variáveis dos artigos analisados foram noctúria, urgência miccional, qualidade de vida, frequência urinária. O PTNS apresentou-se como um método eficaz para o controle da frequência urinária, a noctúria e a incontinência urinária de urgência. CONCLUSÃO: O tratamento através da eletroestimulação percutânea no nervo tibial posterior (PTNS) torna-se um método eficaz, para o controle da frequência urinária, a noctúria e a incontinência urinária de urgência, garantindo a melhora dos sintomas da bexiga hiperativa referida pelos pacientes. [AU]


INTRODUÇÃO: A bexiga hiperativa é uma condição que tem como principal causa a hiperatividade do músculo detrusor e que afeta muitas mulheres. Tem origem idiopática quando não está vinculada a outra patologia. Em contrapartida, quando possui origem neurogênica, tem como causas alterações neurológicas associadas ao mecanismo da micção. Os tratamentos utilizados para a bexiga hiperativa são medicamentoso, fisioterapia e terapia comportamental. Um dos métodos utilizados na fisioterapia é a eletroestimulação do nervo tibial posterior (PTNS), cujo objetivo é impossibilitar a contração involuntária do músculo detrusor de forma exacerbada. OBJETIVO: Identificar o efeito do uso da eletroestimulação percutânea no nervo tibial posterior como forma de tratamento em mulheres com diagnóstico de bexiga hiperativa associada à perda urinária. MATERIAIS E MÉTODOS: Uma revisão sistemática de literatura, que utilizou artigos de ensaios clínicos randomizados encontrados na base de dados Cochrane. A busca dos artigos foi realizada por dois revisores no período compreendido entre agosto e outubro de 2017, realizada de seguinte forma (Urinary Bladder, Overactive AND Tibial nerve AND Transcutaneous Electric Nerve Stimulation). RESULTADOS: Foram encontrados 17 artigos; destes, 4 foram selecionados. As variáveis dos artigos analisados foram noctúria, urgência miccional, qualidade de vida, frequência urinária. O PTNS apresentou-se como um método eficaz para o controle da frequência urinária, a noctúria e a incontinência urinária de urgência. CONCLUSÃO: O tratamento através da eletroestimulação percutânea no nervo tibial posterior (PTNS) torna-se um método eficaz, para o controle da frequência urinária, a noctúria e a incontinência urinária de urgência, garantindo a melhora dos sintomas da bexiga hiperativa referida pelos pacientes. [AU]


Subject(s)
Tibial Nerve , Urinary Bladder , Transcutaneous Electric Nerve Stimulation
20.
Journal of Practical Radiology ; (12): 118-120, 2018.
Article in Chinese | WPRIM | ID: wpr-696770

ABSTRACT

Objective To study the morphology and characteristics of the popliteal tibial nerve and measure relevant structural parameters of the peroneal nerve passing round the fibular head and neck by 3D(three-dimensional)MR advantage sequences,and provide valuable image information for basic research and clinical work.Methods Thirty-six left knee joints of healthy volunteers were scanned using 3D MR sequences,including 3D-FS-CUBE,3D-FS-SPGR.The anatomical features in MR imaging were observed by two doctors.The different level axis section areas of the popliteal tibial nerve were measured by reconstructed 3D MR advantage sequences.The coronal/sagittal diameters and the angle of the fibular head and neck(peroneal tunnel)were also measured and compared.SPSS 19.0 software was used for further statistical analysis.Results Optimum visual rates of the knee nerve of 3D-FS-CUBE,3D-FS-SPGR sequences were 25%,89%(P<0.01).Axial section of the tibial nerve of the popliteal space was as following:top level(Tn1,tibial nerve)(19.3 ± 1.02)mm2,midpoint level(Tn2)(23.6 ± 2.24)mm2,supracondylar level(Tn3)(29.1 ± 3.39)mm2.Coronal and sagittal diameters of the fibular head were(19.8 ± 2.95)mm,(19.7 ± 4.2)mm,and coronal and sagittal diameters of the fibular neck were(12.7 ± 3.1)mm, (13.6 ± 2.5)mm,respectively.The angle between the head and neck was 164°± 6.5°.Conclusion 3D-FS-SPGR sequence is the advantage sequence for displaying the knee nerves.The diameters of the popliteal tibial nerves gradually thicken from Tn 1 to Tn3.The structural measurements of the fibula head and neck have certain significance for fundamental research or prevention and treatment of common peroneal nerve entrapment.

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