股外侧皮神经痛：相关性、诊断与治疗
Meralgia Paresthetica: Relevance, Diagnosis, and Treatment.
作者信息
Scholz Christoph, Hohenhaus Marc, Pedro Maria T, Uerschels Anne-Kathrin, Dengler Nora F
机构信息
Department of Neurosurgery, University Hospital Freiburg, Faculty of Medicine, University of Freiburg; Department of Neurosurgery, Peripheral Nerves Section, University of Ulm at Günzburg District Hospital; Department of Neurosurgery and Spinal Surgery, University Medical Center Essen; Department of Neurosurgery, Charité-University Medical Center Berlin.
出版信息
Dtsch Arztebl Int. 2023 Sep 29;120(39):655-661. doi: 10.3238/arztebl.m2023.0170.
BACKGROUND
Pain and sensory disturbance in the distribution of the lateral femoral cutaneous nerve in the ventrolateral portion of the thigh is called meralgia paresthetica (MP). The incidence of MP has risen along with the increasing prevalence of obesity and diabetes mellitus and was recently estimated at 32 new cases per 100 000 persons per year. In this review, we provide an overview of current standards and developments in the diagnosis and treatment of MP.
METHODS
This review is based on publications retrieved by a selective literature search, with special attention to meta-analyses, systematic reviews, randomized and controlled trials (RCTs), and prospective observational studies.
RESULTS
The diagnosis is mainly based on typical symptoms combined with a positive response to an infiltration procedure. In atypical cases, electrophysiological testing, neurosonography, and magnetic resonance imaging can be helpful in establishing the diagnosis. The literature search did not reveal any studies of high quality. Four prospective observational studies with small case numbers and partly inconsistent results are available. In a meta-analysis of 149 cases, pain relief was described after infiltration in 85% of cases and after surgery in 80%, with 1-38 months of follow-up. In another meta-analysis of 670 cases, there was pain relief after infiltration in 22% of cases, after surgical decompression in 63%, and after neurectomy in 85%. Hardly any data are available on more recent treatment options, such as radiofrequency therapy, spinal cord stimulation, or peripheral nerve stimulation.
CONCLUSION
The state of the evidence is limited in both quantity and quality, corresponding to evidence level 2a for surgical and non-surgical methods. Advances in imaging and neurophysiological testing have made the diagnosis easier to establish. When intervention is needed, good success rates have been achieved with surgery (decompression, neurectomy), and variable success rates with infiltration.
背景
大腿前外侧股外侧皮神经分布区域的疼痛和感觉障碍称为感觉异常性股痛（MP）。随着肥胖症和糖尿病患病率的上升，MP的发病率也随之增加，最近估计每年每10万人中有32例新发病例。在本综述中，我们概述了MP诊断和治疗的当前标准及进展。
方法
本综述基于通过选择性文献检索获得的出版物，特别关注荟萃分析、系统评价、随机对照试验（RCT）和前瞻性观察性研究。
结果
诊断主要基于典型症状以及浸润操作的阳性反应。在非典型病例中，电生理检查、神经超声检查和磁共振成像有助于确诊。文献检索未发现任何高质量研究。有四项病例数少且结果部分不一致的前瞻性观察性研究。在一项对149例病例的荟萃分析中，85%的病例在浸润后疼痛缓解，80%的病例在手术后疼痛缓解，随访时间为1至38个月。在另一项对670例病例的荟萃分析中，22%的病例在浸润后疼痛缓解，63%的病例在手术减压后疼痛缓解，85%的病例在神经切除术后疼痛缓解。关于射频治疗、脊髓刺激或周围神经刺激等最新治疗选择的可用数据很少。
结论
证据的数量和质量都有限，手术和非手术方法的证据水平均为2a级。成像和神经生理检查的进展使诊断更容易确立。当需要干预时，手术（减压、神经切除术）取得了良好的成功率，浸润的成功率则各不相同。
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