Franco Helena, Pagliaro Thomas, Sparti Claudia, Walsh Hp John
Orthopaedic Surgery Department, Mater Hospital, Brisbane, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Orthopaedic Surgery Department, Mater Hospital, Brisbane, Queensland, Australia.
J Foot Ankle Surg. 2023 Sep-Oct;62(5):883-887. doi: 10.1053/j.jfas.2023.06.002. Epub 2023 Jun 21.
This study investigates whether clinical examination is as sensitive as ultrasound and magnetic resonance imaging (MRI) in the diagnosis and localization of symptomatic interdigital neuroma. A retrospective cohort study was conducted at two tertiary centers on all consecutive patients who underwent excision by a single foot and ankle specialist surgeon for a presumed interdigital neuroma between January 2008 and December 2020. Investigators collected preoperative clinical findings, radiological investigations, and postoperative outcomes. Sensitivity and positive predictive values were calculated and Z-score for 2 populations proportions was performed. One hundred fourteen consecutive patients were operated on for 131 suspected interdigital neuroma. Thirteen patients were excluded due to lack of adequate clinical documentation. Of the remaining 101 patients with 118 suspected interdigital neuroma, 115 were confirmed histologically (97.5%). The sensitivity of clinical assessment to accurately diagnose and place an interdigital neuroma in the correct space was calculated as 96.5%. The most common preoperative clinical feature was pain (99.2%). The calculated sensitivity for ultrasound to accurately diagnose an interdigital neuroma was 83.6%, and to correctly locate neuroma was 79.5% respectively, which were both statistically different compared to clinical assessment (p value: <.001 and p value: <.001). The calculated sensitivity for MRI to accurately diagnose an interdigital neuroma was 93.6%, which was statistically different to clinical assessment (p value: .005). Preoperative clinical assessment has the highest sensitivity to accurately diagnose interdigital neuroma when compared to MRI and ultrasound. Preoperative clinical assessment has higher sensitivity to accurately locate interdigital neuroma when compared to ultrasound.
本研究调查了临床检查在有症状的趾间神经瘤诊断和定位方面是否与超声及磁共振成像（MRI）一样敏感。在两家三级医疗中心进行了一项回顾性队列研究，研究对象为2008年1月至2020年12月间由同一位足踝专科医生为疑似趾间神经瘤进行切除手术的所有连续患者。研究人员收集了术前临床检查结果、影像学检查结果及术后转归。计算了敏感度和阳性预测值，并对两个总体比例进行了Z检验。114例连续患者因131个疑似趾间神经瘤接受手术。13例患者因临床记录不充分被排除。在其余101例有118个疑似趾间神经瘤的患者中，115个经组织学确诊（97.5%）。临床评估准确诊断并将趾间神经瘤定位在正确间隙的敏感度计算为96.5%。最常见的术前临床特征是疼痛（99.2%）。超声准确诊断趾间神经瘤的计算敏感度为83.6%，准确定位神经瘤的敏感度为79.5%，与临床评估相比均有统计学差异（p值：<.001和p值：<.001）。MRI准确诊断趾间神经瘤的计算敏感度为93.6%，与临床评估有统计学差异（p值：.005）。与MRI和超声相比，术前临床评估在准确诊断趾间神经瘤方面敏感度最高。与超声相比，术前临床评估在准确定位趾间神经瘤方面敏感度更高。
