背侧入路关节镜下微创神经瘤切除术治疗Morton神经瘤
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1.中国人民解放军东部战区空军医院;2.南京医科大学附属南京医院

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Minimally invasive endoscopic neurectomy using a dorsal approach for Morton’s neuroma
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1.Air Force Hospital of Eastern Theatre Command;2.Nanjing Hospital Affiliated to Nanjing Medical University

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    摘要:

    目的 应用背侧入路关节镜下微创神经瘤切除术治疗Morton 神经瘤,并初步探讨镜下修复跖间横韧带(Transverse intermetatarsal ligament, TIML)的可行性和临床意义。方法 回顾性分析我院应用背侧入路关节镜下微创神经瘤切除术治疗的35例Morton神经瘤临床资料。其中17例于2014年2月至2015年10月行单纯关节镜下神经瘤切除术(对照组),18例于2015年11月至2017年5月行关节镜下神经瘤切除联合TIML 修复术(观察组)。记录并比较两组手术时间、术中出血量和术后并发症,记录术前和末次随访VAS疼痛评分、AOFAS评分评估临床治疗效果;比较两组术前和末次随访时跖骨间角变化,评估TIML修复的效果。结果 所有患者术后随访时间24-38个月。两组间手术时间、出血量,术后敏感性瘢痕、感觉缺失差异无统计学意义(p>0.05)。术前AOFAS评分两组之间差异无统计学意义(p>0.05),末次随访AOFAS评分观察组优于对照组,但两组之间差异无统计学意义(p>0.05)。两组之间术前、末次随访第3跖骨间角相比,差异均无统计学意义(p>0.05);术前与末次随访第3跖骨间角相比,两组均无统计学意义(p>0.05)。结论 背侧入路关节镜下神经瘤切除术是治疗Morton神经瘤可行的微创手术方案,方便修复TIML。短期观察没有发现TIML修复与否对临床结果和跖骨间角的影响。

    Abstract:

    recorded and compared between the two groups. The VAS scores and AOFAS scores recorded preoperatively and at the last follow-up were used to assess for the functional outcomes. Intermetatarsal angles recorded preoperatively and at the last follow-up were compared to evaluate the potential efficacy of TIML repair. [Results] All patients were followed up for 24-38 months. No significant differences were noticed regarding to operation time, intraoperative bleeding, as well as postoperative sensitive scar and sensory defect between the two groups (P>0.05). There was no significant difference in the preoperative AOFAS score between the two groups (p>0.05). The AOFAS scores of the study group were better than that of the control group at the last follow-up, but no significant difference reached between the two groups (p>0.05). In regard to the radiographic metatarsal angle in the third web space, comparison between the two groups preoperatively and at the final follow-up, showed no significant difference, respectively (p>0.05). Of the two groups, statistical analysis both did not show a significance increase of the radiographic intermetatarsal angle at the final follow-up compared with preoperative intermetatarsal angle. [Conclusions] Endoscopic neurectomy using dorsal portals is an effective minimally invasive surgery for Morton’s neuroma. TIML repair or not seems to have no effect on the short- term results of clinical outcomes and the radiographic intermetatarsal angles.

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  • 收稿日期:2019-08-19
  • 最后修改日期:2019-08-19
  • 录用日期:2019-09-12
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