Trauma and Orthopaedic Surgery, University Hospitals of Leicester, Leicester, UK.
Trauma and Orthopaedic Surgery, Royal Berkshire Hospital, Reading, UK.
Foot Ankle Int. 2021 Apr;42(4):464-468. doi: 10.1177/1071100720966332. Epub 2020 Oct 26.
The objective of this study was to evaluate the medium-term results of corticosteroid injections for Morton's neuroma.
This was a prospective follow-up study of a previous randomized controlled trial (RCT). Forty-five neuromas in 36 patients were injected with a single corticosteroid injection either with or without ultrasound guidance. As the results of the RCT showed no difference in outcomes between techniques, the data were pooled for the purpose of this study. Questionnaires were sent out and responses were collected via mail or telephone interview. Results were available in 42 out of 45 neuromas. There was a sex split of 68% female/32% male with a mean age of 62.6 years (SD, 12 years).
At mean follow-up of 4.8 years (SD, 0.91 years), the original corticosteroid injection remained effective in 36% ( = 16) of the patients. In these cases, the visual analog scale (VAS) pain score ( < .001) and Manchester-Oxford Foot Questionnaire Index (MOxFQ Index) ( = .001) remained significantly better than preintervention scores. The remaining cases underwent either a further injection or surgery. Fifty-five percent of the 11 neuromas that received a second injection continued to be asymptomatic in the medium term. Overall, 44% ( = 20) of the initial cohort underwent surgical excision by the medium-term follow-up. The VAS score, MOxFQ Index, and satisfaction scale score across all groups were not significantly different.
Corticosteroid injections for Morton's neuroma remained effective in over a third of cases for up to almost 5 years. A positive outcome at 1 year following a corticosteroid injection was reasonably predictive of a prolonged effect from the injection.
Level II, prospective comparative study.
本研究旨在评估皮质类固醇注射治疗 Morton 神经瘤的中期结果。
这是一项先前随机对照试验（RCT）的前瞻性随访研究。36 名患者的 45 个神经瘤接受了单次皮质类固醇注射治疗，其中一些患者接受了超声引导。由于 RCT 的结果显示两种技术的结果无差异，因此为了本研究的目的，将数据进行了汇总。通过邮件或电话访谈发送问卷，并收集回复。45 个神经瘤中有 42 个有结果。男女比例为 68%女性/32%男性，平均年龄为 62.6 岁（标准差，12 岁）。
平均随访 4.8 年（标准差，0.91 年）后，原始皮质类固醇注射在 36%（=16）的患者中仍然有效。在这些情况下，视觉模拟评分（VAS）疼痛评分（<.001）和曼彻斯特-牛津足部问卷指数（MOxFQ 指数）（=.001）均显著优于干预前评分。其余病例接受了进一步注射或手术。11 个接受第二次注射的神经瘤中有 55%在中期仍无症状。总体而言，在中期随访时，初始队列中有 44%（=20）的患者接受了手术切除。所有组的 VAS 评分、MOxFQ 指数和满意度评分均无显著差异。
Morton 神经瘤的皮质类固醇注射在近 5 年内仍有超过三分之一的病例有效。皮质类固醇注射后 1 年的良好结果可合理预测注射的长期效果。
II 级，前瞻性比较研究。
