Department of Neurological Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA.
Acta Neurochir (Wien). 2021 Feb;163(2):531-543. doi: 10.1007/s00701-020-04241-9. Epub 2020 Feb 13.
Individual evidence suggests that multiple modalities can be used to treat entrapment pathology by Morton's neuroma, including injection, neurolysis, and neurectomy. However, their impacts on patient pain and satisfaction have yet to be fully defined or elucidated. Correspondingly, our aim was to pool systematically identified metadata and substantiate the impact of these different modalities in treating Morton's neuroma with respect to these outcomes.
Searches of 7 electronic databases from inception to October 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidences of outcomes were extracted and pooled by random-effects meta-analysis of proportions.
A total of 35 articles satisfied all criteria, reporting a total of 2998 patients with Morton's neuroma managed by one of the three modalities. Incidence of complete pain relief after injection (43%; 95% CI, 23-64%) was significantly lower than neurolysis (68%; 95% CI, 51-84%) and neurectomy (74%; 95% CI, 66-82%) (P = 0.02). Incidence of complete satisfaction after injection (35%; 95% CI, 21-50%) was significantly lower than neurolysis (63%; 95% CI, 50-74%) and neurectomy (57%; 95% CI, 47-67%) (P < 0.01). The need to proceed to further surgery was significantly greater following injection (15%; 95% CI, 9-23%) versus neurolysis (2%; 95% CI, 0-4%) or neurectomy (5%; 95% CI, 3-7%) (P < 0.01). Incidence of procedural complications did not differ between modalities (P = 0.30).
Although all interventions demonstrated favorable procedural complication incidences, surgical interventions by either neurolysis or neurectomy appear to trend towards greater incidences of complete pain relief and complete patient satisfaction outcomes compared to injection treatment. The optimal decision-making algorithm for treatment for Morton's neuroma should incorporate these findings to better form and meet the expectations of patients.
个体证据表明，多种方法可用于治疗莫顿神经瘤的嵌压病变，包括注射、神经松解和神经切除术。然而，它们对患者疼痛和满意度的影响尚未得到充分确定或阐明。相应地，我们的目的是系统地汇集已确定的元数据，并证明这些不同方法在治疗莫顿神经瘤方面对这些结果的影响。
根据 PRISMA 指南，从成立到 2019 年 10 月对 7 个电子数据库进行了搜索。根据预先规定的标准筛选文章。通过随机效应荟萃分析提取并汇总结局的发生率。
共有 35 篇文章符合所有标准，共报告了 2998 例莫顿神经瘤患者，采用三种方法中的一种进行治疗。注射后完全缓解疼痛的发生率（43%，95%CI，23-64%）明显低于神经松解术（68%，95%CI，51-84%）和神经切除术（74%，95%CI，66-82%）（P=0.02）。注射后完全满意的发生率（35%，95%CI，21-50%）明显低于神经松解术（63%，95%CI，50-74%）和神经切除术（57%，95%CI，47-67%）（P<0.01）。与神经松解术（2%，95%CI，0-4%）或神经切除术（5%，95%CI，3-7%）相比，注射后需要进一步手术的比例明显更高（15%，95%CI，9-23%）（P<0.01）。不同方法之间的手术并发症发生率没有差异（P=0.30）。
尽管所有干预措施的手术并发症发生率都较低，但神经松解术或神经切除术的手术干预似乎比注射治疗更能显著提高完全缓解疼痛和完全患者满意度的发生率。莫顿神经瘤治疗的最佳决策算法应纳入这些发现，以更好地形成和满足患者的期望。
