腓骨神经病的常见原因是腓骨头附近受压。研究表明,减压后效果良好,但病例很少(范围为15-60名患者)。因此,定义良好结果预测因子的尝试是有限的。这里,作者将他们的机构结果与文献中的结果相结合,以确定腓骨神经减压术后良好结果的预测因素.方法作者搜索了他们的机构电子医疗记录,以确定2012年12月1日至2016年9月30日期间进行的所有腓骨神经减压,并创建了IRB批准的数据库。他们还进行了MEDLINE和文献检索,以确定讨论手术减压的文章。所有数据通过荟萃分析相结合,以确定与有利结果相关的因素,定义为术前症状改善。对患者的总体和表现进行了分析(疼痛,感觉异常,弱点,脚下降)。评估的因素包括年龄,性别,身体质量指数,糖尿病,吸烟状况,以前的膝盖或腰椎手术,术前症状持续时间,和病因。对至少三个数据集中评估的任何因素进行荟萃分析。结果71个机构案件有足够的数据供审查。该组的随访时间很长:中位数为29个月,范围12-52个月。在对数据进行汇总分析时,只有糖尿病与减压后不良结局显著相关(p=0.05).在出现疼痛的吸烟者中观察到结果更差的趋势(p=0.06)。结果不受介绍的影响。文献中的另外115例具有可提取的数据进行荟萃分析,和其他协会被看到。术前症状持续时间超过12个月与不良结局相关(OR0.23,95%CI0.08-0.65)。出现感觉异常或感觉减退的患者在症状发作后6个月以上进行手术时,表现出更不利的结局趋势(OR0.37,95%CI0.13-1.06)。即使在荟萃分析之后,结局没有随高龄(OR0.70,95%CI0.24-1.98)或患者性别(OR1.13,95%CI0.42-3.06)而变化.结论作者提供了他们的机构数据以及已发表的关于腓骨神经减压术后结果的数据。结果通常是有利的,并且通常不受术前症状类型的影响。特别是如果患者是非糖尿病患者并且术前症状持续时间少于12个月。感觉异常患者可在发病后6个月内从手术中获益。吸烟可能会对手术结果产生不利影响。最后,高龄不会对结果产生不利影响,和老年患者应考虑手术。
A common cause of peroneal neuropathy is compression near the fibular head. Studies demonstrate excellent outcomes after decompression but include few cases (range 15-60 patients). Consequently, attempts to define predictors of good outcomes are limited. Here, the authors combine their institutional outcomes with those in the literature to identify predictors of good outcomes after peroneal nerve decompression.
The authors searched their institutional electronic medical records to identify all peroneal nerve decompressions performed in the period between December 1, 2012, and September 30, 2016, and created an IRB-approved database. They also conducted a MEDLINE and literature search to identify articles discussing surgical decompression. All data were combined by meta-analysis to identify the factors associated with a favorable outcome, which was defined as improvement in preoperative symptoms. Patients were analyzed in the aggregate and by presentation (pain, paresthesias, weakness, foot drop). The factors evaluated included age, sex, body mass index, diabetes, smoking status, previous knee or lumbar spine surgery, preoperative symptom duration, and etiology. A meta-analysis was completed for any factor evaluated in at least three data sets.
Twenty-one institutional cases had sufficient data for
review. The follow-up among this group was long: median 29 months, range 12-52 months. On aggregate analysis of the data, only diabetes was significantly associated with unfavorable outcomes after decompression (p = 0.05). A trend toward worse outcomes was seen in smokers presenting with pain (p = 0.06). Outcomes were not affected by presentation.An additional 115 cases in the literature had extractable data for meta-analysis, and other associations were seen. Preoperative symptom duration longer than 12 months was associated with unfavorable outcomes (OR 0.23, 95% CI 0.08-0.65). Patients presenting with paresthesias or hypesthesia demonstrated a trend toward more unfavorable outcomes when operated on more than 6 months after symptom onset (OR 0.37, 95% CI 0.13-1.06). Even after the meta-analysis, outcomes did not vary with an advanced age (OR 0.70, 95% CI 0.24-1.98) or with patient sex (OR 1.13, 95% CI 0.42-3.06).
The authors provide their institutional data in combination with published data regarding outcomes after peroneal nerve decompression. Outcomes are typically favorable and generally unaffected by the type of symptoms preoperatively, especially if the patient is nondiabetic and preoperative symptom duration is less than 12 months. Patients with paresthesias may benefit from surgery within 6 months after onset. Smoking may adversely affect surgical outcomes. Finally, an advanced age does not adversely affect outcomes, and older patients should be considered for surgery.