Department of Orthopedics, Balgrist Hospital, University of Zurich, Zurich, Switzerland.
Foot Ankle Int. 2011 Jun;32(6):576-80. doi: 10.3113/FAI.2011.0576.
Alcohol sclerosing therapy has been reported as a safe and effective means of treating interdigital neuromas, both with or without ultrasound. The use of ultrasound introduces beside the ultrasound device, increased cost, and the need for skilled technicians and may reduce usability, especially in the outpatient clinic. We report a series of patients with interdigital neuroma treated using ethanol sclerosing therapy in a clinic setting without the use of ultrasound.
We retrospectively reviewed charts of 32 consecutive patients who were enrolled to receive a series of sclerosing ethanol injections from June 2009 to April 2010 for the treatment of a painful interdigital neuroma. Plain radiographs and MRI scans were obtained if clinically indicated to assistance with the diagnosis. Duration and quality of symptoms were recorded and current pain levels were evaluated on a visual analog pain scale. Previous treatments, including orthotic use, corticosteroid injection, or prior neuroma resection were reported. A solution of 1 ml consisting of 20% ethanol and 0.25% bupivacain solution was injected without the use of ultrasound into the affected webspace. The mixture was provided by the local pharmacy. Technical success was confirmed by the temporary resolution of pain following local anesthetic infiltration. If still symptomatic, an injection was repeated every 2 weeks, with most patients receiving a series of four injections. Pain was evaluated on a visual analog pain scale at each visit. Treatment success was defined as resolution of pain as expressed by the patient.
Of the 32 patients successful relief of symptoms was only achieved in seven patients, while 25 showed no significant reduction of symptoms and considered or underwent a surgical excision.
Alcohol sclerosing therapy administered in the clinic setting without alcohol is not an effective treatment in the nonoperative management of painful interdigital neuromas and has been abandoned in our clinic.
酒精硬化疗法已被报道为一种安全有效的治疗方法，可用于治疗有或没有超声引导的趾间神经瘤。使用超声除了需要超声设备外，还会增加成本，并且需要熟练的技术人员，这可能会降低其可用性，尤其是在门诊环境中。我们报告了一系列在诊所环境中使用无水乙醇硬化疗法治疗趾间神经瘤的患者，未使用超声。
我们回顾性分析了 2009 年 6 月至 2010 年 4 月期间连续收治的 32 例接受一系列硬化性乙醇注射治疗的患者的病历，这些患者患有疼痛性趾间神经瘤。如果临床需要，会进行平片和 MRI 扫描以协助诊断。记录症状的持续时间和质量，并使用视觉模拟疼痛量表评估当前疼痛程度。报告了以前的治疗方法，包括矫形器使用、皮质类固醇注射或先前的神经瘤切除术。在没有使用超声的情况下，将 1 毫升含有 20%乙醇和 0.25%布比卡因溶液的混合物注入受影响的蹼间空间。该混合物由当地药店提供。通过局部麻醉浸润后疼痛暂时缓解来确认技术成功。如果仍有症状，每 2 周重复注射一次，大多数患者接受了一系列 4 次注射。每次就诊时使用视觉模拟疼痛量表评估疼痛。治疗成功定义为患者表示疼痛缓解。
在 32 例患者中，仅 7 例患者的症状得到缓解，而 25 例患者的症状无明显减轻，被认为或接受了手术切除。
在没有超声引导的情况下，在诊所环境中进行的酒精硬化疗法不是治疗疼痛性趾间神经瘤的有效非手术治疗方法，并且已在我们的诊所中被放弃。
