Yap Lee Pheng, McNally Eugene
Radiology Department, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia.
J Clin Ultrasound. 2012 Jul-Aug;40(6):330-4. doi: 10.1002/jcu.21926. Epub 2012 May 15.
Assess patient discomfort during two different methods of injection of Morton's neuroma.
Sixty-eight patients referred for ultrasound-guided injection of Morton's neuroma had punctures performed dorsal or plantar to the interdigital skin crease, with and without preliminary subcutaneous local anesthesia (LA). Patients rated discomfort during skin puncture (SP) and needle advancement (NA) using a visual analog scale.
Average pain score was 4.4 ± 2.3 (1 SD) for the plantar approach and 2.9 ± 2.0 for the dorsal approach. This difference was statistically significant during SP (p < 0.01) and NA (p < 0.05). During the plantar approach with LA, mean pain score during SP was 4.4 (± 2.1) and 3.9 (± 2.8) during NA. This plantar approach without LA resulted in a pain score of 4.3 (± 2.6) and 3.8 (± 3.1), respectively. Mean pain scores for patients injected from the dorsal approach with LA during SP were 3.8 (± 2.7) and NA were 2.2 (± 2.0) and without LA were 2.6 (± 1.9) and 3.0 (± 2.1). There was no statistical significance in mean pain score difference during SP and NA, with and without LA for either the plantar (p > 0.05) or the dorsal (p > 0.05) approach.
Injection of Morton's neuroma was better tolerated via a dorsal approach and use of preliminary LA did not confer any benefit.
评估两种不同方法注射 Morton 神经瘤时患者的不适程度。
68 例因超声引导下注射 Morton 神经瘤前来就诊的患者，在指间皮肤皱褶的背侧或跖侧进行穿刺，分为有和没有预先皮下局部麻醉（LA）两组。患者使用视觉模拟量表对皮肤穿刺（SP）和进针（NA）过程中的不适程度进行评分。
跖侧进针的平均疼痛评分为 4.4±2.3（1 个标准差），背侧进针为 2.9±2.0。在 SP（p<0.01）和 NA（p<0.05）过程中，这种差异具有统计学意义。在跖侧进针并使用 LA 时，SP 期间的平均疼痛评分为 4.4（±2.1），NA 期间为 3.9（±2.8）。这种不使用 LA 的跖侧进针分别导致疼痛评分为 4.3（±2.6）和 3.8（±3.1）。背侧进针且使用 LA 的患者在 SP 期间的平均疼痛评分为 3.8（±2.7），NA 期间为 2.2（±2.0）；不使用 LA 时分别为 2.6（±1.9）和 3.0（±2.1）。对于跖侧（p>0.05）或背侧（p>0.05）进针，在有和没有 LA 的情况下，SP 和 NA 期间平均疼痛评分差异均无统计学意义。
通过背侧进针注射 Morton 神经瘤的耐受性更好，且预先使用 LA 并无益处。
