甲泼尼龙注射治疗 Morton 神经瘤：一项患者盲法随机试验。

Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial.

机构信息

Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh EH21 6UU, Scotland.

出版信息

J Bone Joint Surg Am. 2013 May 1;95(9):790-8, S1. doi: 10.2106/JBJS.I.01780.

DOI:10.2106/JBJS.I.01780

PMID:23636185

Abstract

BACKGROUND

Morton neuroma is a common cause of neuralgia affecting the web spaces of the toes. Corticosteroid injections are commonly administered as a first-line therapy, but the evidence for their effectiveness is weak. Our primary research aim was to determine whether corticosteroid injection is an effective treatment for Morton neuroma compared with an anesthetic injection as a placebo control.

METHODS

We performed a pragmatic, patient-blinded randomized trial set within hospital orthopaedic outpatient clinics in Edinburgh, United Kingdom. One hundred and thirty-one participants with Morton neuroma (mean age, fifty-three years; 111 [85%] female) were randomized to receive either corticosteroid and anesthetic (1 mL methylprednisolone [40 mg] and 1 mL 2% lignocaine) or anesthetic alone (2 mL 1% lignocaine). An ultrasonographic image was obtained before treatment, and injections were performed with the needle placed under ultrasonographic guidance. The primary outcome was the difference in patient global assessment of foot health between the two groups at three months after injection. This was measured with use of a 100-unit visual analog scale (VAS) anchored by "best imaginable health state" and "worst imaginable health state."

RESULTS

Compared with the control group, global assessment of foot health in the corticosteroid group was significantly better at three months (mean difference, 14.1 scale points [95% confidence interval, 5.5 to 22.8 points]; p = 0.002). The difference between the groups was also significant at one month. Significant and nonsignificant improvements associated with the corticosteroid injection were observed for measures of pain, function, and patient global assessment of general health at one and three months after injection. The size of the neuroma as determined by ultrasonography did not significantly influence the treatment effect.

CONCLUSIONS

Corticosteroid injections for Morton neuroma can be of symptomatic benefit for at least three months.

摘要

背景

莫顿神经瘤是一种常见的神经痛病因，影响脚趾的蹼间隙。皮质类固醇注射通常作为一线治疗，但它们的疗效证据较弱。我们的主要研究目的是确定皮质类固醇注射是否比麻醉注射作为安慰剂对照更能有效治疗莫顿神经瘤。

方法

我们在英国爱丁堡的医院骨科门诊进行了一项实用的、患者盲法的随机试验。131 名莫顿神经瘤患者（平均年龄 53 岁；111 名[85%]女性）被随机分为接受皮质类固醇和麻醉剂（1 毫升甲泼尼龙[40 毫克]和 1 毫升 2%利多卡因）或单独麻醉剂（2 毫升 1%利多卡因）治疗。在治疗前获得超声图像，并在超声引导下将针插入。主要结局是注射后三个月两组患者足部健康的总体评估差异。这是通过使用 100 个单位的视觉模拟量表（VAS）测量的，其锚定在“最佳想象健康状态”和“最差想象健康状态”。

结果

与对照组相比，皮质类固醇组的足部健康总体评估在三个月时明显更好（平均差异为 14.1 个量表点[95%置信区间，5.5 至 22.8 点]；p = 0.002）。组间差异在一个月时也很显著。在注射后一个月和三个月时，观察到疼痛、功能和患者对一般健康的总体评估的测量值与皮质类固醇注射相关的显著和非显著改善。超声检查确定的神经瘤大小并没有显著影响治疗效果。