Iturregui Jose M, Haupt Edward T, Wilke Benjamin K, Kraus Jonathan C, Shi Glenn G
Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
Department of Orthopedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Foot Ankle Int. 2023 Mar;44(3):171-177. doi: 10.1177/10711007221149028. Epub 2023 Feb 6.
The deep peroneal nerve (DPN) plays a role in afferent nociceptive dorsal midfoot joint pain perception. DPN neurectomy for treatment of symptomatic dorsal midfoot osteoarthritis allows early mobilization and weightbearing. The purpose of our study was to evaluate the patient satisfaction and pain relief after DPN neurectomy for treatment of chronic dorsal midfoot pain due to osteoarthritis.
In this retrospective, IRB-approved, questionnaire-based study, we evaluated 48 patients (55 feet) with an average follow-up of 35.1 (range, 16-51) months who underwent DPN neurectomy at our institution between September 2017 and February 2021. There were 38 women and 10 men, 41 unilateral (22 right, 19 left) and 7 bilateral procedures, with an average age of 67.8 (range, 35-88) years at the time of surgery. A questionnaire that included questions regarding postsurgical dorsal midfoot pain relief, surgical result satisfaction, and current functional limitations was administered via telephone. Demographic information, patient responses, and complications were recorded.
Of the 48 patients, 80.8% were satisfied with the result of the surgery in relieving their dorsal midfoot pain, 84.6% would repeat the surgery under the same circumstances, 83.8% would recommend the surgery to a friend, 10.4% reported they wish they had undergone arthrodesis, 91.7% reported pain relief in the first 6 months, and 55.6% reported current activity limitations. Six feet (10.9%) underwent a second procedure with an average postoperative time of 20.5 (range, 1-36) months. Complications included 1 hematoma and deep wound infection, 1 DPN neuroma and superficial peroneal nerve entrapment, and 4 patients with inadequate pain relief.
In this cohort, DPN neurectomy appeared to be a reasonable surgical alternative to arthrodesis for the management of chronic dorsal midfoot pain due to midfoot osteoarthritis after failed nonoperative management.
Level IV, retrospective case series.
腓深神经（DPN）在传入性伤害性中足背关节疼痛感知中起作用。DPN神经切除术用于治疗有症状的中足背骨关节炎，可使患者早期活动和负重。我们研究的目的是评估DPN神经切除术治疗因骨关节炎导致的慢性中足背疼痛后的患者满意度和疼痛缓解情况。
在这项经机构审查委员会批准的回顾性问卷调查研究中，我们评估了48例患者（55足），平均随访35.1（范围16 - 51）个月，这些患者于2017年9月至2021年2月在我们机构接受了DPN神经切除术。其中有38名女性和10名男性，41例为单侧手术（22例右侧，19例左侧），7例为双侧手术，手术时平均年龄为67.8（范围35 - 88）岁。通过电话发放一份问卷，其中包括有关术后中足背疼痛缓解、手术结果满意度以及当前功能受限情况的问题。记录人口统计学信息、患者回答和并发症情况。
48例患者中，80.8%对手术缓解中足背疼痛的结果感到满意，84.6%表示在相同情况下会再次接受该手术，83.8%会向朋友推荐该手术，10.4%报告希望当初接受的是关节融合术，91.7%报告在最初6个月疼痛得到缓解，55.6%报告目前存在活动受限。6足（10.9%）接受了二次手术，术后平均时间为20.5（范围1 - 36）个月。并发症包括1例血肿和深部伤口感染、1例DPN神经瘤和腓浅神经卡压，以及4例疼痛缓解不足的患者。
在这个队列中，对于非手术治疗失败的中足骨关节炎所致慢性中足背疼痛的管理，DPN神经切除术似乎是一种合理的手术替代关节融合术的方法。
IV级，回顾性病例系列。
