Foot and Ankle Unit, Policlinico Abano Terme Private Hospital, Piazza C. Colombo 1, Abano Terme, Padua, Italy.
Department of Gastroenterology, University of Verona, Piazzale L.A. Scuro 10, Verona, Italy.
Radiol Med. 2016 Jul;121(7):597-604. doi: 10.1007/s11547-016-0622-9. Epub 2016 Feb 16.
To evaluate the efficacy and safety of percutaneous treatment of Civinini-Morton's syndrome due to solitary Morton's neuroma and analyze the effect of clinico-demographic factors on outcome.
Alcohol injection was performed under sonographic guidance in 220 consecutive patients. Pain intensity using a numerical rating scale (NRS), pain features, limitation of everyday activities and comorbidity with other forefoot conditions were evaluated at presentation. Patients were reassessed for symptoms and the need of rescue therapy with neurectomy after a mean follow-up of 19.0 months (range 15-24).
We treated 220 patients (33 males, mean age 55.8 years). Neuromas were located in the III intermetatarsal space in 85.5 %, with a mean size of 5.4 mm. When considering a reduction of pain intensity of ≥50 % of NRS or a complete disappearance of the neuropathic features as a satisfactory clinical response, a 72.3 % (p < 0.001) responder rate was obtained, and only three patients relapsed (1.2 %). An improvement in limitation of everyday activities was observed in 88.6 % (p < 0.001). No influence of clinico-demographic variables on outcome was found. No major complications occurred. Patients with unsatisfactory response had an overload-related comorbid condition in 20/61 (32.8 %). Surgery was later performed in 14 non-responder patients.
Ultrasound-guided alcoholization demonstrated a safe profile, relieved neuropathic symptoms in a majority of patients and improved their quality of life. Rescue therapy with surgery is feasible in patients with unsatisfactory response. However, a thorough evaluation for forefoot comorbidities should be obtained, as they may act as confounding factors.
评估经皮治疗因单一 Morton 神经瘤引起的 Civinini-Morton 综合征的疗效和安全性，并分析临床 - 人口统计学因素对结果的影响。
在 220 例连续患者中，在超声引导下进行酒精注射。在就诊时评估疼痛强度（使用数字评分量表[NRS]）、疼痛特征、日常活动受限和前足其他疾病的共病情况。在平均随访 19.0 个月（范围 15-24）后，对患者进行症状和需要接受神经切除术的救援治疗的评估。
我们治疗了 220 例患者（33 例男性，平均年龄 55.8 岁）。神经瘤位于第三跖骨间空间，占 85.5%，平均大小为 5.4mm。当考虑 NRS 疼痛强度降低≥50%或神经病变特征完全消失作为满意的临床反应时，获得了 72.3%（p<0.001）的应答率，仅 3 例患者复发（1.2%）。88.6%（p<0.001）的患者观察到日常活动受限的改善。未发现临床 - 人口统计学变量对结果的影响。未发生重大并发症。在 61 例不满意反应的患者中，有 20 例（32.8%）存在与负荷相关的共病情况。后来对 14 例无反应患者进行了手术。
超声引导下的酒精化显示出安全的特征，缓解了大多数患者的神经病变症状，并改善了他们的生活质量。在不满意反应的患者中，手术的救援治疗是可行的。然而，应该获得前足共病情况的全面评估，因为它们可能是混杂因素。
