HIRURŠKO LEČENJE PADA STOPALA NAKON POVREDE PERONEALNOG ŽIVCA
Sažetak
Pad stopala je često kliničko stanje koje se prezentuje nemogućnošću podizanja stopala, karakteristano gubitkom dorzifleksije skočnog zgloba od strane m. tibialis anterior i gubitkom everzije stopala od strane m. peroneus longus i m. peroneus brevisa, praćeno gubitkom senzibiliteta ili utrnulošću dorzuma stopala. Uzroci pada stopala mogu se desiti na bilo kom delu puta nerva, a lezije se prema prirodi mogu podeliti na kompresivne poremećaje, traumatske povrede i neurološka oštećenja. Peronealna paraliza zbog kompresije nerva je najčešći periferni uzrok. Lečenje i dijagnoza pada stopala zahtevaju bolju standardizaciju, a pad stopala je i dalje klasifikovan kao klinički znak drugih oboljenja. Uzevši u obzir multidisciplinarnu prirodu pada stopala, nije uvek lako odrediti uzrok. Kako konzervativno, tako i hirurško lečenje imaju svoje mesto u tretmanu pada stopala. Konzervativne procedure korišćene za lečenje pada stopala obuhvataju fizikalnu terapiju, funkcionalnu električnu stimulaciju, ortoze i proteze, pomoćne naprave i trening hoda. Zavisno od uzroka pada stopala, dostupno je nekoliko različitih hirurških tehnika za uspešno lečenje. Oslobađanje lišnjačnog živca smatra se procedurom niskog rizika sa odličnim rezultatima kao što su umanjenje bola i povratak funkcije. Ako je kontinuitet nerva oštećen biće učinjena direktna sutura nerva epineuralnim šavovima pod uveličanjem. Još jedan hirurški pristup koji je u literaturi opisan kao uspešan je transfer živca. Uobičajeno se kao donor nervnog grafta koristi suralni nerv. Za transfer tetive najčešće se uzima m. tibialis posterior. Kako se tetiva prebacuje na dorzum stopala, pomaže pri dorzifleksiji. Nakon svih hirurških procedura, savetuje se da pacijenti počnu sa ranom mobilizacijom i postoperativnom fizikalnom terapijom. Bolja standardizacija terapija pada stopala je i dalje potrebna. Ipak, hirurške procedure pokazuju visok stepen uspešnosti, bolje rezultate i brži oporavak ukoliko se sprovedu unutar prvih nekoliko meseci od povrede.
Reference
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