Lu Victor M, Burks S Shelby, Heath Rainya N, Wolde Tizeta, Spinner Robert J, Levi Allan D
1Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and.
2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
J Neurosurg. 2021 Jan 15;135(3):912-922. doi: 10.3171/2020.7.JNS202191. Print 2021 Sep 1.
Meralgia paresthetica is caused by entrapment of the lateral femoral cutaneous nerve (LFCN) and often presents with pain. Multiple treatment options targeting the LFCN can be pursued to treat the pain should conservative measures fail, with the most common options being injection, neurolysis, and neurectomy. However, their efficacy in causing pain relief and their clinical outcomes have yet to be directly compared. The aim of this study was to interrogate the contemporary literature and quantitatively define how these options compare.
The electronic databases Ovid Embase, PubMed, SCOPUS, and the Cochrane Library were interrogated from inception to May 2020 following the PRISMA guidelines. Candidate articles were screened against prespecified criteria. Outcome data were abstracted and pooled by random-effects meta-analysis of proportions.
There were 25 articles that satisfied all criteria, reporting outcomes for a total of 670 meralgia paresthetica patients, with 78 (12%) treated by injection, 496 (74%) by neurolysis, and 96 (14%) by neurectomy. The incidence of complete pain relief was 85% (95% CI 71%-96%) after neurectomy, 63% (95% CI 56%-71%) after neurolysis, and 22% (95% CI 13%-33%) after injection, which were all statistically different (p < 0.01). The incidence of revision procedures was 12% (95% CI 4%-22%) after neurolysis and 0% (95% CI 0%-2%) after neurectomy, which were significantly lower than 81% (95% CI 64%-94%) after injection (p < 0.01). The incidences of treatment complications were statistically comparable across all three treatments, ranging from 0% to 5% (p = 0.34).
There are multiple treatment options to target pain in meralgia paresthetica. The incidence of complete pain relief appears to be the greatest among the 3 interventions after neurectomy, accompanied by the lowest incidence of revision procedures. These findings should help inform patient preference and expectations. Greater exploration of the anatomical rationale for incomplete pain relief after surgical intervention will assist in optimizing further surgical treatment for meralgia paresthetica.
股外侧皮神经卡压综合征（MP）由股外侧皮神经（LFCN）卡压所致，常表现为疼痛。若保守治疗无效，可采用多种针对LFCN的治疗方法来缓解疼痛，最常见的方法包括注射、神经松解术和神经切除术。然而，它们在缓解疼痛方面的疗效及其临床结果尚未得到直接比较。本研究的目的是查阅当代文献并定量确定这些方法的比较情况。
按照PRISMA指南，检索电子数据库Ovid Embase、PubMed、SCOPUS和Cochrane图书馆，检索时间从建库至2020年5月。根据预先设定的标准筛选候选文章。通过随机效应比例荟萃分析提取并汇总结果数据。
有25篇文章符合所有标准，共报告了670例股外侧皮神经卡压综合征患者的治疗结果，其中78例（12%）接受注射治疗，496例（74%）接受神经松解术治疗，96例（14%）接受神经切除术治疗。神经切除术后完全缓解疼痛的发生率为85%（95%CI 71%-96%），神经松解术后为63%（95%CI 56%-71%），注射治疗后为22%（95%CI 13%-33%），差异均有统计学意义（p<0.01）。神经松解术后翻修手术的发生率为12%（95%CI 4%-22%），神经切除术后为0%（95%CI 0%-2%），均显著低于注射治疗后的81%（95%CI 64%-94%）（p<0.01）。三种治疗方法的治疗并发症发生率在统计学上具有可比性，范围为0%至5%（p=0.34）。
股外侧皮神经卡压综合征有多种针对疼痛的治疗方法。神经切除术后完全缓解疼痛的发生率似乎在三种干预措施中最高，同时翻修手术的发生率最低。这些发现有助于告知患者的偏好和期望。进一步探讨手术干预后疼痛缓解不完全的解剖学原理，将有助于优化股外侧皮神经卡压综合征的进一步手术治疗。
