Bauer Thomas, Gaumetou Elodie, Klouche Shahnaz, Hardy Philippe, Maffulli Nicola
Department of Orthopaedic Surgery, Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, Boulogne-Billancourt, France.
Department of Orthopaedic Surgery, Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, Boulogne-Billancourt, France.
J Foot Ankle Surg. 2015 May-Jun;54(3):373-7. doi: 10.1053/j.jfas.2014.08.009. Epub 2014 Dec 4.
The present study compared the clinical results of open neurectomy versus a percutaneous procedure for Morton's disease. This was a retrospective study comparing the functional results after 2 surgical procedures: open neurectomy and a percutaneous procedure (with deep transverse metatarsal ligament release and distal metatarsal osteotomies). The present study included 52 patients (26 in each group), and the mean follow-up period was 4 (range 2 to 7) years. The patient evaluation criteria included the presence of painful symptoms of Morton's disease, American Orthopaedic Foot and Ankle Society (AOFAS) functional scale score, patient satisfaction, and delay for recovery. Percutaneous treatment of Morton's disease and open neurectomy produced complete relief of pain in 25 of 26 patients in each group. At the latest follow-up visit, the mean AOFAS score had significantly improved from 36 ± 11 preoperatively to a mean of 89 ± 18 (p < .001). After 2 years, the functional improvement obtained with the percutaneous procedure persisted, with a stable AOFAS score (96 ± 10). Persistent metatarsalgia was reported by patients who had undergone open neurectomy, with a significantly decreased AOFAS score (81 ± 21, p = .009). The percutaneous procedure for Morton's disease provided excellent functional outcomes (AOFAS score >90) significantly more often with a shorter delay than after open neurectomy (p = .03). At the latest follow-up visit, metatarsalgia due to plantar hyperpressure or bursitis and requiring plantar orthotics was present in 11 of 26 patients (44%) after open neurectomy and in 1 of 26 patients (4%) after the percutaneous procedure (p = .002). Percutaneous treatment of Morton's disease is a reliable procedure providing results as good as those after open neurectomy, with significantly better outcomes in the longer term and a lower rate of late metatarsalgia.
本研究比较了开放性神经切除术与经皮手术治疗莫顿氏病的临床结果。这是一项回顾性研究，比较了两种手术（开放性神经切除术和经皮手术（包括深层横跖韧带松解和跖骨远端截骨术））后的功能结果。本研究纳入了52例患者（每组26例），平均随访期为4年（范围2至7年）。患者评估标准包括莫顿氏病疼痛症状的存在、美国矫形足踝协会（AOFAS）功能量表评分、患者满意度以及恢复延迟情况。经皮治疗莫顿氏病和开放性神经切除术在每组26例患者中均有25例疼痛完全缓解。在最近一次随访时，平均AOFAS评分从术前的36±11显著提高到平均89±18（p<.001）。2年后，经皮手术获得的功能改善持续存在，AOFAS评分稳定（96±10）。接受开放性神经切除术的患者报告有持续性跖痛，AOFAS评分显著降低（81±21，p=.009）。与开放性神经切除术后相比，经皮治疗莫顿氏病更常提供优异的功能结果（AOFAS评分>90），且延迟时间更短（p=.03）。在最近一次随访时，开放性神经切除术后26例患者中有11例（44%）因足底高压或滑囊炎出现跖痛且需要足底矫形器，而经皮手术后26例患者中有1例（4%）出现这种情况（p=.002）。经皮治疗莫顿氏病是一种可靠的手术，其结果与开放性神经切除术后的结果一样好，从长期来看结果明显更好，且晚期跖痛发生率更低。
Zotero 插件