1 Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
2 Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Foot Ankle Int. 2019 May;40(5):545-552. doi: 10.1177/1071100719828375. Epub 2019 Feb 2.
Neuroma results from disorganized regeneration following nerve injury and may be symptomatic. The aim of this study was to investigate the causes, treatment, and outcomes of operatively treated sural neuromas, and to describe the factors associated with persistent or unchanged postoperative pain symptoms.
Consecutive patients with surgically treated sural neuromas in a 14-year period were identified using Current Procedural Terminology (CPT) codes ( n = 49), followed by a chart review to collect patient and treatment characteristics. Postoperative pain symptoms were categorized as complete resolution of pain, improvement of pain, no change in pain, or worse pain. The median patient age was 46.5 years (interquartile range [IQR], 39.1-51.3), and median follow-up was 4.0 years (IQR, 1.9-9.2).
Ninety percent of symptomatic sural neuromas developed as a result of previous lower extremity surgery. Initial surgery of sural neuroma led to improvement in pain in 63% of patients, and an additional 8.2% of the patients had improvement after secondary neuroma surgery. Pain relief after diagnostic injection showed a trend toward an association with postoperative pain improvement. Neuroma excision and implantation in muscle was the most common surgical technique used (67%). Four of the 7 patients that underwent a second neuroma operation reported symptom improvement.
Sural neuromas may arise from prior surgery or trauma to the lower extremity. Surgical intervention resulted in either improvement or complete resolution of pain symptoms in 71% of patients, although occasionally more than one procedure was required to obtain symptomatic relief. Preoperative anesthetic injection may help identify patients that benefit from neuroma surgery. Level of Evidence: Level IV, retrospective case series.
神经瘤是由于神经损伤后的无序再生而产生的，可能会出现症状。本研究旨在调查手术治疗腓肠神经瘤的病因、治疗方法和结果，并描述与术后持续性或无变化的疼痛症状相关的因素。
使用当前程序术语 (CPT) 代码（n=49）确定了 14 年间接受手术治疗的腓肠神经瘤连续患者，随后进行图表审查以收集患者和治疗特征。术后疼痛症状分为疼痛完全缓解、疼痛改善、疼痛无变化或疼痛加重。患者的中位年龄为 46.5 岁（四分位距 [IQR]，39.1-51.3），中位随访时间为 4.0 年（IQR，1.9-9.2）。
90%的有症状的腓肠神经瘤是由于下肢手术引起的。初次手术治疗腓肠神经瘤后，63%的患者疼痛得到改善，另有 8.2%的患者在二次神经瘤手术后疼痛得到改善。诊断性注射后的疼痛缓解显示与术后疼痛改善有一定关联。腓肠神经瘤切除和肌肉植入是最常用的手术技术（67%）。在接受第二次神经瘤手术的 7 名患者中，有 4 名患者报告症状改善。
腓肠神经瘤可能是由下肢先前的手术或创伤引起的。手术干预使 71%的患者的疼痛症状得到改善或完全缓解，尽管有时需要多次手术才能获得症状缓解。术前麻醉注射可能有助于确定从神经瘤手术中受益的患者。
IV 级，回顾性病例系列。
