Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Upper Extremity and Reconstructive Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University.
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
J Plast Reconstr Aesthet Surg. 2020 Aug;73(8):1456-1464. doi: 10.1016/j.bjps.2020.01.034. Epub 2020 Jan 23.
Traumatic neuroma caused by injuries or surgery can result in neuropathic pain, functional impairment, and psychological distress, which has an impact on quality of life. The aim of this study was to identify the factors related to successful treatment of symptomatic lower extremity symptomatic neuromas using patient-reported outcome measures (PROMs).
Thirty-two patients with 48 symptomatic neuromas completed the PROMIS mobility, PROMIS pain interference (PI), Numeric Rating Scale (NRS) for pain (0-10) for both pre- and post-operative pain, and the PROMIS depression at a mean of 8.9±4.5 years following neuroma surgery. Neuromas were located around the foot and ankle (n=18, 38%), leg (n=14, 29%), around the knee (n=13, 27%), and in the thigh (n=3, 6.3%). Surgical treatment included neuroma excision and implantation (n=29, 60%) followed by neuroma excision alone or excision with placement in the subcutaneous tissue (n=12, 25%). We performed multivariable analysis to identify the factors influencing the PROMs.
Patients reported significant reduction in mean NRS pain after surgery (7.3 vs 4.9, p=0.0013). Higher PROMIS depression scores were independently associated with inferior PROMIS mobility scores (β=-0.38, p=0.001), higher PROMIS PI scores (β=0.68, p<0.001), and higher NRS pain scores (β=0.1, p=0.001). Additionally, smoking was independently associated with higher NRS pain scores (β=1.59, p=0.049) CONCLUSION: Surgical treatment of symptomatic neuromas of the lower extremity provides a long-term improvement in 59% of patients, but 19% of patients still reported severe persistent pain despite surgical treatment. Smoking and negative mood have negative effects on patient-reported outcomes after neuroma surgery.
创伤性神经瘤由损伤或手术引起，可导致神经病理性疼痛、功能障碍和心理困扰，从而影响生活质量。本研究旨在通过患者报告的结局测量（PROMs）来确定与成功治疗症状性下肢症状性神经瘤相关的因素。
32 名患有 48 个症状性神经瘤的患者完成了 PROMIS 移动性、PROMIS 疼痛干扰（PI）、术前和术后疼痛的数字评定量表（NRS）（0-10），以及 PROMIS 抑郁在神经瘤手术后平均 8.9±4.5 年。神经瘤位于足部和踝关节（n=18，38%）、腿部（n=14，29%）、膝关节周围（n=13，27%）和大腿（n=3，6.3%）。手术治疗包括神经瘤切除和植入（n=29，60%），随后单独切除神经瘤或切除后放置在皮下组织（n=12，25%）。我们进行了多变量分析，以确定影响 PROMs 的因素。
患者报告手术后平均 NRS 疼痛显著减轻（7.3 对 4.9，p=0.0013）。较高的 PROMIS 抑郁评分与较低的 PROMIS 移动性评分（β=-0.38，p=0.001）、较高的 PROMIS PI 评分（β=0.68，p<0.001）和较高的 NRS 疼痛评分（β=0.1，p=0.001）独立相关。此外，吸烟与较高的 NRS 疼痛评分独立相关（β=1.59，p=0.049）。
下肢症状性神经瘤的手术治疗可使 59%的患者长期受益，但 19%的患者尽管接受了手术治疗仍报告严重持续性疼痛。吸烟和负面情绪对神经瘤手术后患者报告的结局有负面影响。
