Younger A S, Claridge R J
Department of Orthopedics, University of British Columbia, Vancouver.
Can J Surg. 1998 Apr;41(2):127-30.
To determine the outcome of surgical excision of Morton's neuroma after a local anesthetic diagnostic block into the neuroma has relieved symptoms.
A cohort study.
A university affiliated hospital.
A sequential series of 37 patients who underwent 41 excisions with at least 2 years' follow-up. Seven patients had undergone repeat excision of a neuroma, and 34 primary excisions were performed. Surgery was performed by a specialist in orthopedic surgery of the foot and ankle.
Excision of the Morton's neuroma after a positive diagnostic block.
Grade of symptoms at follow-up done by independent review on a 4-point scale.
Of 41 procedures, 11 had an unfavourable outcome: 4 procedures were graded 3, and 7 procedures were graded 4. Eight (24%) of the 34 primary procedures were reported as failures, and 3 (43%) of the 7 revision procedures were reported as failures. Most patients reported poor results owing to persistent pain.
Diagnostic blocks do not improve the results of surgery for excision of Morton's neuroma and are not recommended. Because failure rates are greater than 20%, surgery for Morton's neuroma should only be offered after a full course of nonoperative management.
确定在对莫顿神经瘤进行局部麻醉诊断性阻滞缓解症状后，手术切除该神经瘤的效果。
队列研究。
一家大学附属医院。
连续37例患者接受了41次切除手术，随访至少2年。7例患者接受了神经瘤重复切除，34例为初次切除。手术由足踝整形外科专家进行。
在诊断性阻滞阳性后切除莫顿神经瘤。
由独立评估采用4分制对随访时的症状分级。
41例手术中，11例效果不佳：4例评为3级，7例评为4级。34例初次手术中有8例（24%）报告为失败，7例翻修手术中有3例（43%）报告为失败。大多数患者报告因持续疼痛效果不佳。
诊断性阻滞不能改善莫顿神经瘤切除手术的效果，不建议采用。由于失败率大于20%，莫顿神经瘤手术应仅在经过完整的非手术治疗疗程后进行。
