Melendez Mark M, Patel Anup, Dellon A Lee
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT.
J Foot Ankle Surg. 2016 Mar-Apr;55(2):320-3. doi: 10.1053/j.jfas.2014.09.045. Epub 2014 Dec 5.
Joplin's neuroma is a rare perineurial fibrosis of the medial plantar digital proper nerve arising from various etiologies but most commonly after bunion surgery. Treatment for this painful great toe problem remains controversial. It is our purpose to describe our experience with this chronic pain problem, considering it to be a neuroma requiring resection. A retrospective medical record review of 8 patients with medial hallux pain related to the digital nerve was performed. Each patient had failed to respond to >6 months of nonoperative therapy. At surgery, the medial digital nerve to the hallux was identified distally, the neuroma was resected distally, and the proximal end of the nerve was implanted into the arch of the foot in 7 (87.5%) of the 8 patients. At a mean follow-up of 25 (range 13 to 43) months, 6 results (75%) were excellent, 1 (12.5%) was good, and 1 (12.5%) was fair. The 1 fair result was in the only patient in whom the distal end of the divided nerve was not implanted proximally, according to the patient's request. In conclusion, surgical resection of the medial plantar nerve to the hallux with implantation of the proximal end of the nerve into the arch of the foot, can be expected to result in good to excellent relief of pain in 80% of the patients.
乔普林神经瘤是一种罕见的足底内侧趾固有神经的神经周纤维化，病因多样，但最常见于拇囊炎手术后。针对这个导致大脚趾疼痛的问题，治疗方法仍存在争议。我们的目的是描述我们在处理这个慢性疼痛问题方面的经验，将其视为需要切除的神经瘤。我们对8例与趾神经相关的拇囊炎内侧疼痛患者的病历进行了回顾性研究。每位患者对6个月以上的非手术治疗均无反应。手术时，在远端识别出拇趾的内侧趾神经，将神经瘤在远端切除，8例患者中有7例（87.5%）将神经近端植入足弓。平均随访25个月（范围13至43个月），6例（75%）结果为优，1例（12.5%）为良，1例（12.5%）为中。唯一结果为中的患者是根据其自身要求未将离断神经的远端近端植入的那例患者。总之，切除拇趾的足底内侧神经并将神经近端植入足弓，预计80%的患者疼痛能得到良好至极佳的缓解。
