治疗由隐神经髌下支术后或创伤后神经瘤引起的慢性膝关节疼痛。

Management of chronic knee pain caused by postsurgical or posttraumatic neuroma of the infrapatellar branch of the saphenous nerve.

机构信息

The Peripheral Nerve Reconstruction Unit, Department of Neurosurgery and Orthopedic Surgery, Tel Aviv University, Tel Aviv, Israel.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

J Orthop Surg Res. 2021 Jul 21;16(1):464. doi: 10.1186/s13018-021-02613-0.

DOI:10.1186/s13018-021-02613-0

PMID:34289862

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8293565/

Abstract

PURPOSE

Injury to the infrapatellar branch of the saphenous nerve (IBSN) is a relatively common complication after knee surgery, which can interfere with patient satisfaction and functional outcome. In some cases, injury to the IBSN can lead to formation of a painful neuroma. The purpose of this study was to report the results of surgical treatment in a series of patients with IBSN painful neuroma.

METHODS

We retrospectively identified 37 patients who underwent resection of IBSN painful neuroma at our institution, after failure of non-operative treatment for a minimum of 6 months. Injury to the IBSN resulted from prior orthopedic surgery, vascular surgery, tumor resection, trauma, or infection. Leg pain and health-related quality of life were measured using the numeric rating scale (NRS) and EuroQol 5 dimensions (EQ-5D) questionnaire, respectively. Clinically meaningful improvement in leg pain was defined as reduction in NRS by at least 3 points. Predictors of favorable and unfavorable surgical outcome were investigated using multivariable logistic regression analysis.

RESULTS

Patient-reported leg pain, health-related quality of life, and overall satisfaction with the surgical outcome were obtained at 94 ± 52.9 months after neuroma surgery. Postoperative patient-reported outcomes were available for 25 patients (68% of the cohort), of whom 20 patients (80.0%) reported improvement in leg pain, 17 patients (68.0%) reported clinically meaningful improvement in leg pain, and 17 patients (68%) reported improvement in health-related quality of life. The average NRS pain score improved from 9.43 ± 1.34 to 5.12 ± 3.33 (p < 0.01) and the average EQ-5D functional score improved from 10.48 ± 2.33 to 7.84 ± 2.19 (p < 0.01). Overall patient reported satisfaction with the surgical outcome was good to excellent for 18 patients (72.0%). Older age, multiple prior orthopedic knee surgeries, and failed prior attempts to resect an IBSN neuroma were associated with non-favorable surgical outcome.

CONCLUSION

We conclude that surgical intervention is efficacious for appropriately selected patients suffering from IBSN painful neuroma.

摘要

目的

隐神经髌下支（IBSN）损伤是膝关节手术后一种较为常见的并发症，可影响患者满意度和功能结果。在某些情况下，IBSN 损伤可导致疼痛性神经瘤形成。本研究旨在报告一系列 IBSN 疼痛性神经瘤患者手术治疗的结果。

方法

我们回顾性地确定了 37 名在我院接受 IBSN 疼痛性神经瘤切除术的患者，这些患者在非手术治疗至少 6 个月后均未成功。IBSN 损伤是由先前的矫形外科手术、血管外科手术、肿瘤切除、创伤或感染引起的。腿部疼痛和健康相关生活质量分别使用数字评分量表（NRS）和欧洲五维健康量表（EQ-5D）问卷进行测量。将 NRS 至少降低 3 分定义为腿部疼痛的临床显著改善。使用多变量逻辑回归分析调查手术结果有利和不利的预测因素。

结果

在神经瘤手术后 94 ± 52.9 个月获得了患者报告的腿部疼痛、健康相关生活质量和对手术结果的总体满意度。25 名患者（队列的 68%）获得了术后患者报告的结果，其中 20 名患者（80.0%）报告腿部疼痛改善，17 名患者（68.0%）报告腿部疼痛具有临床意义的改善，17 名患者（68.0%）报告健康相关生活质量改善。NRS 疼痛评分从 9.43 ± 1.34 平均改善至 5.12 ± 3.33（p < 0.01），EQ-5D 功能评分从 10.48 ± 2.33 平均改善至 7.84 ± 2.19（p < 0.01）。18 名患者（72.0%）对手术结果的总体报告满意度为良好至优秀。年龄较大、多次先前的膝关节矫形手术以及先前尝试切除 IBSN 神经瘤失败与手术结果不佳相关。