"靶向肌肉神经再支配治疗莫顿神经瘤的可行性"。
"The Feasibility of Targeted Muscle Reinnervation for the Management of Morton's Neuroma".
机构信息
Department of Plastic Surgery, The University of Virginia, Charlottesville, Virginia (SIK, CVS, BRD).
Department of Orthopaedic Surgery, The University of Virginia, Charlottesville, Virginia (MTC, BRD).
出版信息
Foot Ankle Spec. 2022 Feb;15(1):76-81. doi: 10.1177/19386400211002702. Epub 2021 Dec 2.
BACKGROUND
Despite multiple surgical modalities available for the management of Morton's neuroma, complications remain common. Targeted muscle reinnervation (TMR) has yet to be explored as an option for the prevention of recurrence of Morton's neuroma. The purpose of the present investigation was to determine the consistency of the relevant foot neurovascular and muscle anatomy and to demonstrate the feasibility of TMR as an option for Morton's neuroma.
METHODS
The anatomy of 5 fresh-tissue donor cadaver feet was studied, including the course and location of the medial and lateral plantar nerves (MPNs and LPNs), motor branches to abductor hallucis (AH) and flexor digitorum brevis (FDB), as well as the course of sensory plantar digital nerves. Measurements for the locations of the muscular and sensory branches were taken relative to landmarks including the navicular tuberosity (NT), AH, FDB, and the third metatarsophalangeal joint (third MTPJ).
RESULTS
The mean number of nerve branches to FDB identified was 2. These branch points occurred at an average of 8.6 cm down the MPN or LPN, 9.0 cm from the third MTPJ, 3.0 cm distal to AH distal edge, and 4.8 cm from the NT. The mean number of nerves to AH was 2.2. These branch points occurred at an average of 6.3 cm down the MPN, 11.9 cm from the third MTPJ, 0.8 cm from the AH distal edge, and 3.8 cm from the NT.
CONCLUSIONS
Recurrent interdigital neuroma, painful scar, and neuropathic pain are common complications of operative management for Morton's neuroma. Targeted muscle reinnervation is a technique that has demonstrated efficacy for the prevention and treatment of neuroma, neuropathic pain, and phantom limb pain in amputees. Herein, we have described the neuromuscular anatomy for the application of TMR for the management of Morton's neuroma. Target muscles, including the AH and FDB, have consistent innervation patterns in the foot, and consequently, TMR represents a viable option to consider for the management of recalcitrant Morton's neuroma.
LEVELS OF EVIDENCE
V.
背景
尽管有多种手术方法可用于治疗 Morton 神经瘤，但并发症仍然很常见。靶向肌肉神经再支配（TMR）尚未被探索作为预防 Morton 神经瘤复发的一种选择。本研究的目的是确定相关足部神经血管和肌肉解剖结构的一致性，并证明 TMR 作为 Morton 神经瘤的一种选择的可行性。
方法
研究了 5 只新鲜组织供体尸体足的解剖结构，包括内侧和外侧足底神经（MPN 和 LPN）、展肌（AH）和趾短屈肌（FDB）的运动支以及感觉足底指神经的走行。测量了肌肉和感觉支相对于跟骨结节（NT）、AH、FDB 和第三跖趾关节（第三 MTPJ）等标志的位置。
结果
识别出的 FDB 神经分支的平均数量为 2 条。这些分支点位于 MPN 或 LPN 下方平均 8.6cm 处、第三 MTPJ 下方 9.0cm 处、AH 远端边缘 3.0cm 处和 NT 下方 4.8cm 处。AH 的平均神经数量为 2.2 条。这些分支点位于 MPN 下方平均 6.3cm 处、第三 MTPJ 下方 11.9cm 处、AH 远端边缘 0.8cm 处和 NT 下方 3.8cm 处。
结论
复发性趾间神经瘤、疼痛性瘢痕和神经性疼痛是 Morton 神经瘤手术治疗的常见并发症。靶向肌肉神经再支配是一种已证明对预防和治疗截肢后神经瘤、神经性疼痛和幻肢痛有效的技术。在此，我们描述了 TMR 应用于 Morton 神经瘤管理的神经肌肉解剖结构。包括 AH 和 FDB 在内的目标肌肉在足部具有一致的神经支配模式，因此 TMR 是治疗顽固性 Morton 神经瘤的可行选择。
证据水平
V 级。
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