Background

Individual evidence suggests that multiple modalities can be used to treat entrapment pathology by Morton’s neuroma, including injection, neurolysis, and neurectomy. However, their impacts on patient pain and satisfaction have yet to be fully defined or elucidated. Correspondingly, our aim was to pool systematically identified metadata and substantiate the impact of these different modalities in treating Morton’s neuroma with respect to these outcomes.

Methods

Searches of 7 electronic databases from inception to October 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidences of outcomes were extracted and pooled by random-effects meta-analysis of proportions.

Results

A total of 35 articles satisfied all criteria, reporting a total of 2998 patients with Morton’s neuroma managed by one of the three modalities. Incidence of complete pain relief after injection (43%; 95% CI, 23–64%) was significantly lower than neurolysis (68%; 95% CI, 51–84%) and neurectomy (74%; 95% CI, 66–82%) (P = 0.02). Incidence of complete satisfaction after injection (35%; 95% CI, 21–50%) was significantly lower than neurolysis (63%; 95% CI, 50–74%) and neurectomy (57%; 95% CI, 47–67%) (P < 0.01). The need to proceed to further surgery was significantly greater following injection (15%; 95% CI, 9–23%) versus neurolysis (2%; 95% CI, 0–4%) or neurectomy (5%; 95% CI, 3–7%) (P < 0.01). Incidence of procedural complications did not differ between modalities (P = 0.30).

Conclusions

Although all interventions demonstrated favorable procedural complication incidences, surgical interventions by either neurolysis or neurectomy appear to trend towards greater incidences of complete pain relief and complete patient satisfaction outcomes compared to injection treatment. The optimal decision-making algorithm for treatment for Morton’s neuroma should incorporate these findings to better form and meet the expectations of patients.

中文翻译：

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通过注射，神经溶解或神经切除术治疗莫顿神经瘤：对疼痛和满意度的系统评价和荟萃分析。

背景

个别证据表明，莫顿神经瘤可采用多种方式治疗包埋病理，包括注射，神经溶解和神经切除术。但是，它们对患者痛苦和满意度的影响尚未完全确定或阐明。相应地，我们的目的是集中系统地识别元数据，并根据这些结果证实这些不同方式对治疗莫顿神经瘤的影响。

方法

根据PRISMA指南，从成立到2019年10月对7个电子数据库进行了搜索。根据预先指定的标准筛选文章。结果的发生率通过比例的随机效应荟萃分析提取和汇总。

结果

共有35篇文章满足所有标准，报告共有2998例由三种方式之一管理的莫顿神经瘤患者。注射后完全缓解疼痛的发生率（43％； 95％CI，23–64％）显着低于神经溶解（68％； 95％CI，51–84％）和神经切除术（74％； 95％CI，66–66） 82％）（P  = 0.02）。注射后完全满意的发生率（35％； 95％CI，21–50％）显着低于神经溶解（63％； 95％CI，50–74％）和神经切除术（57％； 95％CI，47–67） ％）（P  <0.01）。注射后（15％; 95％CI，9–23％）相比神经溶解（2％; 95％CI，0–4％）或神经切除术（5％; 95％CI， 3–7％）（P <0.01）。两种方法的手术并发症发生率无差异（P  = 0.30）。

结论

尽管所有干预措施均显示出良好的程序并发症发生率，但与注射治疗相比，通过神经溶解或神经切除术进行的外科手术干预措施似乎趋向于出现更大的完全缓解疼痛和完全患者满意结果的趋势。莫顿神经瘤治疗的最佳决策算法应结合这些发现，以更好地形成并满足患者的期望。