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伝導検査では, 健常人でも導出困難例が存在すると言われ, いわゆるルーチン検査の被検神経として選択していない施設も多い。この導出困難例については正座習慣による潜在性腓骨神経障害が存在するためと推測されてきたが, 検証はされていない。近年, 生活習慣は変化していることから, 健常成人の下肢神経伝導検査所見の経年変化を検討した。, 脛骨神経複合運動活動電位 (CMAP) 振幅は, 1995年以降では有意に増大していた。これらの変化には, 体格や検査時の栄養状態による影響は低く, 運動習慣, 椅子生活への変化などの生活スタイルの変化が影響している可能性を考えた。の伝導検査は, 1995年以降ではCMAP振幅は有意に増大し導出も容易となっており, 異常の判定も容易になっていると考えた。今後, がルーチン検査の被検神経として広く使われることが望ましい。

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  Introduction : Strangulated common peroneal neuropathy is a well-known cause of foot drop. However, it can also present solely with pain and numbness in the area of the common peroneal nerve, necessitating differentiation from lumbar degenerative diseases. Additionally, it has also been reported to occur after lumbar spinal surgery and may cause failed back surgery syndrome (FBSS). We treated four patients diagnosed with common peroneal neuropathy due to residual or new symptoms in the lower leg following posterior lumbar decompression surgery. All patients underwent common peroneal nerve neurolysis (CPNN) under local anesthesia. Herein, we report our experience with these cases.

  Case Presentation : Case 1 : An 80-year-old man diagnosed with lumbar spinal canal stenosis (L4/5) developed pain and numbness in the right lower leg approximately 3 months after surgery, despite initial symptoms improvement. No motor paralysis was observed. CPNN was performed, and the patient recovered well.

  Case 2 : A 74-year-old man with left L5/S1 disc herniation presented with pain in the dorsal aspect of the left lower extremity for which he underwent herniectomy. His postoperative symptoms initially improved ; however, 4 months later, he developed pain in the left lower leg and foot drop and underwent CPNN. Postoperatively, the pain and foot drop improved, but motor palsy persisted, with an Manual Muscle Testing (MMT) 4.

  Case 3 : An 81-year-old woman underwent posterior decompression surgery for lumbar spinal canal stenosis (L4/5). She experienced residual pain and numbness in her lower leg after the surgery and was diagnosed with common peroneal neuropathy. Her pain was rated 7 on the Numerical Rating Scale (NRS), with no evidence of motor palsy. CPNN was performed and her symptoms improved.

  Case 4 : An 84-year-old woman diagnosed with lumbar spinal canal stenosis (L3/4, 4/5) underwent posterior lumbar decompression surgery. Two years later, pain and numbness developed in the right lower leg. She exhibited tibialis anterior motor palsy with MMT 4. CPNN was performed, resulting in postoperative symptoms improvement.

  Conclusion : Four cases of common peroneal neuropathy with residual or new-onset pain and numbness in the lateral leg after lumbar spinal canal stenosis and lumbar disc herniation were reported. CPNN improved pain and numbness in all patients. All patients exhibited tenderness of the common peroneal nerve at the peroneal head and Tinel-like signs, which were useful for diagnosis. Accurate diagnosis and surgical intervention are expected to improve patient outcomes.

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We reported two cases of compression neuropathy of the common peroneal nerve misdiagnosed and treated as lateral meniscus lesions.
Case 1. A 24-year-old man complaining both knee pain had visited a hospital and had been diagnosed as both lateral menicus lesions. He had accepted four times arthroscopic surgery on each knee in the hospital during 10 years. Because his pain remained unchanged, he visited our clinic in August 1997.
Case 2. A 24-year-old female had accepted arthroscopic meniscectomy for left lateral knee pain. Postoperative course was uneventful. Two years after the operation, she noticed left lateral knee pain and spastic feeling on the lateral aspect of her left leg. She visited the same hospital. She was diagnosed as having recurrence of lateral meniscus tear and was suggested operative treatment. She visited our clinic in April 1999.
We diagnosed these patients having a compression neuropathy of the common peroneal nerve and tried nerve blocks at compression site. Since the effect of the blocks was temporary, neurolysis was performed. The complaints of the patients disappeared in the evening of the operative day and they satisfied the results.
On differential diagnosis of lateral knee pain, it should be differentiate compression neuropathy of the common Peroneal nerve.

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【目的】膝窩嚢腫は外来診療においてよく遭遇する疾患であるが，神経刺激症状を伴うものはまれである．我々は刺激症状を伴った膝窩嚢腫の一例を経験したので若干の文献的考察を加え報告する．【症例】45歳女性，約2ヶ月前より左膝後外側に腫瘤を触知し，伸展位で明らかな神経脱落症状はみられなかったが，最大屈曲時に下腿外側のしびれが増強した．左膝のレントゲンは明らかな異常は認められなかった．MRIで膝窩部に5×3×3cmの腫瘤性病変を認め，腫瘤は膝窩筋腱と腓腹筋外側頭との間から，外側側副靱帯まで連続して認められ，は腫瘤に前後を挟まれるように存在していた．関節造影検査にて関節腔との交通は認められなかったため，直視下嚢腫摘出手術を施行し，病理所見より膝窩嚢腫と診断した．術後6ヶ月の時点で再発は認めず，復職している．

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【はじめに】 梨状筋症候群とは、坐骨神経をはじめとする末梢神経が骨盤出口部で梨状筋により絞扼や圧迫などの侵害刺激を受けることで、疼痛や痺れが惹起される病態である。また、障害される神経は、教科書的には坐骨神経とされているが、実際の臨床では後大腿皮神経や下殿神経の症状も呈することが多い。そのため、臨床症状が多様化ことも少なくない。今回、末梢神経障害を臨床症状から分類し、その割合について検討を行ったので報告する。
【対象】 対象は、2012年1月から6月までに梨状筋症候群と診断された25例（男性8例、女性17例、右13肢、左11肢、左右1肢）である。平均年齢は54.3±19.7歳であり、発症から来院までの期間は平均52.7±66.0日であった。
【方法】 末梢神経障害の識別方法について述べる。後大腿皮神経（第1-3仙骨神経）は、感覚枝のみを有する。そのため、臀部下部から大腿後面における神経領域内に疼痛及び感覚障害を認めた場合とした。（第4腰神経－第2仙骨神経）と脛骨神経（第4腰神経－第3仙骨神経）は感覚枝と運動枝を有する。そのため、前者は、下腿外側から足背における疼痛及び感覚障害と長母趾伸筋の筋力低下を認めた場合とし、後者は、下腿後面から足底における疼痛および感覚障害と長母趾屈筋の筋力低下を認めた場合とした。上殿神経（第4腰神経－第1仙骨神経）と下殿神経（第5腰神経－第2仙骨神経）は運動枝のみを有する。前者は、中殿筋の筋力低下や萎縮を認めた場合とし、後者は、大臀筋の筋力低下や萎縮を認めた場合とした。
　また、それぞれを単独例と合併例に分類した。
【結果】 神経別に分類すると、障害は22/25例（88.0%）、後大腿皮神経障害は21/25例（84.0%）と多く認められ、下殿神経障害は3/25例（12.0%）、上殿神経障害は2/25例（8.0%）となった。脛骨神経障害の症例は、0/25例（0%）であり、今回の検討では認めなかった。
　症状別に分類すると、後大腿皮神経+16/25例（64.0%）、後大腿皮神経+下殿神経1/25例（4.0%）、後大腿皮神経++上殿神経群1/25例（4.0%）、後大腿皮神経++下殿神経群1/25例（4.0%）、後大腿皮神経++上殿神経+下殿神経群が1/25例（4.0%）であった。単独例は、3/25例（12.0%）、後大腿皮神経2/25例（8.0%）であった。
【考察】 梨状筋症候群は、坐骨神経の障害とされているが、今回の調査では主にと後大腿皮神経による障害を多く認める結果となった。また、少数ではあるが下殿神経と上殿神経障害も認められた。つまり、梨状筋症候群の病態把握や治療には、坐骨神経のみならず、他の末梢神経障害の合併も考慮した複合的な病態把握が重要と考えられる。

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Drop foot occur by peroneal nerve palsy, lumbar disease, motor neuron disease and so on. We examined 19 patients of drop foot and it was useful for diagnosis.
The anomaly of M wave is classified in to three types, conduction slowing, conduction block, and low ampulitude type. The spinal disease (3 lumbar canal stenosis, 2 lumbar disc herniation, 2 Charcot Marie Tooth disease, 1 syringmyelia and 1 tetherd cord syndrome) all showed low ampulitude type and peroneal nerve palsy (10) showed 4 conduction block and 6 low ampulitude type.
If the M wave was of the low ampulitude type, we examined somatosensory evoked potential which was recorded from lumbar surface region (mainly L4/5). To use this methord we could diagnose peroneal nerve palsy to spinal disease. Electrophysiological tests are useful for the diagnosis of the drop foot.

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Intraneural hemangioma is an extremely rare condition. To our knowledge, only one case of hemangioma within the common peroneal nerve has been reported. We present an additional case. A 48-year-old male was seen on May 20, 1999 complaining of severe left knee pain and paresthesia on the lateral aspect of the left lower leg and dorsum of the foot. Physical examination revealed swelling and marked tenderness of the left common peroneal nerve in the lateral proximal region of the popliteal fossa. A Tinel's sign along the nerve in the popliteal fossa was present. Hypesthesia over the peroneal nerve distribution and a weakness of the toe extensor was present.
He was diagnosed as compression syndrome of the common peroneal nerve.
After failed conservative treatment with vitaminn B1, 12 and antiinflammatory drugs, surgical decompression was carried out. At surgery, in the proximal region of the popliteal fossa, a dark red mass of about 2cm surrounding the common peroneal nerve was noted, and distal to this tumor another three smaller bluish masses on the nerve were also noted.
Decompression of the nerve by opening the epineurium and incision of aponeurotic part of the biceps muscle were carried out, because dissection of the tumor without injury to the nerve was considered imposssible. Postoperative course was uneventful. However after five months, disabling pain recurred and second operation was carried out. Intrafascicular dissection of the tomor was intended but bleeding from the cavities of the tumor prevented further dissection, and ligation of the nutrient vessels of the nerve near the tumor was carried out. After deflation of the pneumatic tourniquet, the size of the tumor was reduced and blood supply of the nerve was seen to be normal. Five months after the second operation, the patient had no pain and no sensory disturbance.

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41 limbs in 34 patients with entrapment neuropathy of the common peroneal nerve were operated on in our department. Among these, 11 limbs in 7 cases were diagnosed as having osteoarthritis, and 11 limbs in 11 case as lumbar disc herniation before our diagnosis.
The causes of these misdiagnoses were investigated with medical care records.
The causes of misdiagnoses as lumbar disc herniations were as follows: paresthesia from the lateral aspect of the leg to the dorsal aspect of the foot as the patient complaint, misunderstanding of the symptoms from the extension and compression of the common peroneal nerve as a positive SLRT (straight leg raising test), relying on image studies without precise examination of the physical findings, and no consideration of the entrapment neuropathy as a differential diagnosis.
The causes of misdiagnoses as knee joint disorders were as follows: gonalgia as the patient complaint, diagnosis relying on image studies without precise examination of the physical findings, and no consideration of the entrapment neuropathy as a differential diagnosis.
In the diagnosis of lumbar spinal and knee joint disorders, the entrapment neuropathy of the common peroneal nerve should be considered as a differential diagnosis.

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前・後骨間神経麻痺における神経のくびれはその成因として着目されている．しかし，下肢の神経におけるくびれの存在は我々の渉猟し得た限りではない．今回，左麻痺の術中所見で神経にくびれが存在した症例を経験したので報告する．症例は74歳，女性．RAにて平成15年4～5月に両側THA，左TKAを行ったが，特に誘引なく6月始め頃より左麻痺症状が出現した．完全麻痺であったこと，原因不明であったこと，Tinel様微侯がなかったこと，1ヶ月保存的治療を行うも改善傾向がなかったことから7月に神経剥離術とRAのためのADL障害を考慮に入れて機能再建術を行った．術中所見では神経剥離を行うと浅腓骨神経にくびれがみられた．再建術は後脛骨筋腱を移行するWatkins-Barr法に準じて行った．本症例は神経にくびれがみられたことにより，多数回手術によるストレスが原因での神経炎の可能性があると思われた．

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The present study was carried out to investigate whether there was any modulation of the spinal monosynaptic reflexes during mastication in the healthy humans and urethaneanesthetized rabbits and to elucidate the central neural mechanisms responsible for the modulation in the urethane-anesthetized rabbits.
1. Human soleus H-reflex was significantly facilitated during the rhythmical jaw movements and rhythmical gum chewing.
2. There was no significant difference in the magnitude of the facilitation between the jawopening and -closing phases.
3. In the rabbits, monosynaptic reflex (MSR) volleys recorded from the tibial nerve (TIB) innervating the crural extensors and the common peroneal nerve (CP) innervating the crural flexors tonically increased in amplitude during the masticatory movements induced by either intraoral stimulation or repetitive stimulation of the cortical masticatory area (CMA) .
4. Antidromic field potentials in the anterior horn of the lumbar cord evoked by the stimulation of TIB and CP increased during the CMA-induced actual and fictive mastication.
5. There was no significant change in the amplitude of the directly evoked antidromic potential in the primary afferents by intraspinal stimulation during the CMA-induced mastication compared with the resting state.
It was concluded that (1) the MSR of the crural muscles undergoes a tonic non-reciprocal facilitation during mastication, (2) the Stomatognathic afferents induced during mastication are not essential for the facilitation, and (3) an increase in the excitability of motoneurons is mainly involved in the facilitation of the MSR during mastication.

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胃癌にて開腹手術を施行した2症例に, 術直後より, それぞれ一過性の腕神経叢麻痺, 腓骨神経麻痺を認めた症例を経験した. 症例1: 50歳の男性で, 開腹手術後より両側足背部のしびれ感および両下腿の運動障害を認めた. Vit B12を投与し理学療法を行い, 1か月後, 足関節の背屈困難もほとんど消失し退院となった. 症例2: 46歳の男性で, 開腹手術直後より両上肢の知覚および運動麻痺を認めた. ステロイド, Vit B12を投与し理学療法, 星状神経節ブロックを行った結果, 術後6か月で全治した. 術中の体位による合併症として, まれに腓骨神経麻痺, 腕神経叢麻痺が挙げられる. その発生要因としては, 術中肢位による神経の過伸展, 圧迫が主なものと考えられている. 今回われわれは, 胃癌手術後に麻痺および両側腕神経叢麻痺をきたした症例を経験したので, 文献的考察を加え報告する.

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Seven patients required removal of peripheral nerve trunks due to resecion of bone and soft tissue tumors. After resection of the tumor with the diseased portion of the nerve trunk, five patients underwent immediate repair of the nerve (interposition nerve graft, the length of 8-13cm). Two patients each had malignent shwannoma and malignant fibrous histiocytoma, and one patient had a neurilemoma. Ages of the patients ranged from thirty to sixty years. Five were female. The proximal thigh and proximal lower leg was involved in two patients each and the groin in one patient each. The distal common peroneal nerve was used as the graft for repair of the proximal tibial nerve in two patients who had resection of the sciatic nerve, the distal superficial peroneal nerve was used for proximal deep peroneal nerve repair in one patient in whom the common peroneal neve was resected and the sural nerve was used for common peroneal nerve repair in one patient with resection of the common peroneal nerve. The median follow-up was 45 monrhs. Four patients (80%) achieved a good recovery of the repaired nerve function and one patient (25%) had minimal recovery.

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