背景:目前的文献缺乏比较足底和背侧方法治疗Civinini-Morton综合征的临床结果的全面信息,也被称为莫顿神经瘤。进行了系统评价和荟萃分析,以评估和比较Morton神经瘤的神经切除术的临床结果。重点研究足底入路和背侧入路的差异。
方法:我们的综合文献综述遵循了系统评价和荟萃分析(PRISMA)指南的首选报告项目,并利用了包括PubMed,Embase,WebofScience,还有Cochrane图书馆.这项研究中调查的数据包括术后感觉丧失,疤痕压痛,再操作,组织病理学,并发症,疼痛评分,患者满意度,功能分数,和负重时间。
结果:本研究共纳入8项研究。总的来说,使用足底入路切除237例神经瘤,而312个神经瘤通过背侧入路治疗。在背侧组中发现术后感觉降低的比率明显更高:48.5%(64/132)Vs。62.0%(80/129),相对比率(RR)为0.79(95%CI,0.64-0.97)。足底组术后瘢痕压痛的发生率明显更高:16.7%(32/192)Vs。6.2%(14/225),RR为2.27(95%CI,1.28-4.04)。关于组织病理学,足底入路和背侧入路的准确率分别为99.3%(143/144)和97.1%(134/138),分别,RR为1.02(95%CI,0.98-1.07)。两组之间的总体再手术和并发症没有差异,足底组为5.3%(10/189)和8.8%(19/216),背侧组为6.1%和12.0%(35/291)。
结论:我们建议在手术前与患者进行详细讨论,以权衡每种方法的优缺点。
BACKGROUND: Current literature lacks comprehensive information comparing the clinical outcomes of plantar and dorsal approaches for Civinini-Morton syndrome, also known as Morton\'s neuroma. This systematic
review and meta-analysis was conducted to evaluate and compare the clinical outcomes of neurectomy for Morton\'s neuroma, focusing on the differences between the plantar and dorsal approach.
METHODS: Our comprehensive literature
review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and utilized databases including PubMed, Embase, Web of Science, and the Cochrane Library. Data investigated in this study included postoperative sensory loss, scar tenderness, reoperation, histopathology, complications, pain score, patient satisfaction, functional scores, and time to weight bearing.
RESULTS: Total eight studies were included in this study. In aggregate, 237 neuromas underwent
excision using the plantar approach, while 312 neuromas were treated via the dorsal approach. A significantly higher rate of postoperative reduced sensory was found in the dorsal group: 48.5 % (64/132) Vs. 62.0 % (80/129) with the relative ratio (RR) of 0.79 (95 % CI, 0.64-0.97). A significantly higher rate of postoperative scar tenderness was noted in the plantar group: 16.7 % (32/192) Vs. 6.2 % (14/225) with the RR of 2.27 (95 % CI, 1.28-4.04). Regarding the histopathology, 99.3 % (143/144) and 97.1 % (134/138) accuracy rate was confirmed in the plantar approach and dorsal approach, respectively, with the RR of 1.02 (95 % CI, 0.98-1.07). Overall reoperations and complications were not different between groups at 5.3 % (10/189) and 8.8 % (19/216) in the plantar group versus 6.1 % and 12.0 % (35/291) in dorsal group.
CONCLUSIONS: We recommend detailed discussions with patients prior to surgery to weigh the advantages and disadvantages of each approach.