Morton神经瘤的诊疗进展

Progress of diagnosis and treatment of Morton's neuroma

Morton神经瘤是前足疼痛的常见原因,好发于中年女性,通常在第三跖骨间隙;病理机制尚未完全明确,但普遍认为是慢性创伤所致。Morton神经瘤的典型症状是跖趾关节水平存在局部疼痛、感觉异常或刺痛感;临床诊断准确性高。治疗Morton神经瘤的方法尚无金标准,非手术治疗包括非侵入性和侵入性治疗(如超声引导下射频消融、Ⅰ型胶原注射等),手术治疗传统采用神经切除术,目前最近的进展是在超声、荧光显微镜、神经电图和经皮电极刺激技术辅助下的乙醇和类固醇注射,以及神经松解术伴或不伴神经背侧移位、跖骨间深横韧带松解、跖骨截骨术、神经横断或神经切除术后的附加靶向肌肉神经移植等,旨在提高诊断的准确性、治疗的有效性,从而改善整体临床预后。

Morton's neuroma is a prevalent cause of forefoot pain,predominantly affecting middle-aged women and typically occurring in the third intermetatarsal space.The precise pathological mechanism remains unclear,with the chronic trauma theory being the most widely accepted explanation.Patients commonly present with localized pain,paresthesia,or tingling at the level of the metatarsophalangeal joint.Clinical diagnosis is generally accurate,although no definitive gold standard for treatment exists.Non-surgical management includes both non-invasive and invasive options,such as ultrasound-guided radiofrequency ablation and type I collagen injections.Neurotomy represents the traditional surgical intervention.Recent advancements in treatment include ultrasound-assisted ethanol and steroid injections,the utilization of fluorescence microscopy,electroneurography,percutaneous electrode stimulation techniques,and neurolysis,with or without dorsal nerve displacement.Additional procedures such as the release of the deep transverse metatarsal ligament,metatarsal osteotomy,and targeted muscle nerve reinnervation following nerve transection or neurectomy are aimed at enhancing diagnostic precision and therapeutic efficacy,thereby improving the overall clinical outcomes for patients with this condition.