Pain Relief Following Selective Tibial Neurotomy for Spastic Equinus Foot Secondary to Stroke and Traumatic Brain Injury
Pain Relief Following Selective Tibial Neurotomy for Spastic Equinus Foot Secondary to Stroke and Traumatic Brain Injury
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选择性胫神经切断术治疗继发于中风和创伤性脑损伤的痉挛马蹄足后的疼痛缓解
DOI：
10.1016/j.wneu.2022.07.053
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发表时间：
2022
影响因子：
2
通讯作者：
Tooru Inoue
中科院分区：
文献类型：
--
作者：
Kazunori Oda ; Takashi Morishita ; Aya Yatsugi ; Koichi Miki ; Takuya Uchiyama ; Hideaki Tanaka ; Hiroshi Abe ; Tooru Inoue
目的选择性胫神经切断术（STN）已适用于痉挛性马蹄足（SEF）；然而，该手术对生活质量和日常生活活动的影响尚未得到详细评估。本研究旨在评估 STN 的手术结果及其对伴随疼痛的 SEF 的影响。方法我们评估了 26 名因 SEF 接受 STN 的患者（平均年龄：59.6 ± 15.2 岁；14 名男性和 12 名女性），其中 10 名患者术前主诉自发性疼痛。我们使用以下量表进行临床评估：改良阿什沃斯量表、医学研究委员会 (MRC)、10 米步行测试、功能独立测量和疼痛数字评定量表。这些量表在术前和术后进行了评估。比较10名疼痛患者和16名无疼痛患者的临床特征差异。结果除功能独立测量外，所有评估量表评分均观察到显着差异，且未报告严重不良事件。疼痛强度从 6.4±2.0 显着改善至 2.7±2.3（P<0.05）。分析显示，疼痛患者的术前踝关节运动平均医学研究委员会评分显着较低，但术后 6 个月随访时恢复到相同水平。结论我们的研究显示痉挛及其相关症状显着改善，STN 有效解决痉挛性疼痛和运动无力。在各种治疗方式中，STN 可能对小腿痉挛性疼痛患者有积极作用。
ObjectiveSelective tibial neurotomy (STN) has been indicated for spastic equinus foot (SEF); however, the impact of this procedure on quality of life and activities of daily living has not been evaluated in detail. This study aimed to evaluate the surgical outcomes of STN and its effect on SEF accompanied by pain.MethodsWe evaluated 26 patients (mean age: 59.6 ± 15.2 years; 14 men and 12 women) who underwent STN for SEF, 10 of whom complained of spontaneous pain preoperatively. We used the following scales for clinical evaluation: the Modified Ashworth Scale, Medical Research Council (MRC), 10-m walking test, Functional Independence Measure, and numeric rating scale for pain. These scales were evaluated preoperatively and postoperatively. Differences in clinical characteristics were compared between the 10 patients with pain and the 16 patients without pain.ResultsSignificant differences were observed in all evaluation scale scores except for the Functional Independence Measure, and no serious adverse events were reported. Pain intensity was significantly improved from 6.4 ± 2.0 to 2.7 ± 2.3 (P< 0.05). An analysis showed that the preoperative mean Medical Research Council score of ankle movement was significantly lower in patients with pain but recovered to the same level postoperatively at the 6-month follow-up.ConclusionsOur study showed significant improvements in spasticity and its associated symptoms, and STN effectively addressed spastic pain and motor weakness. Among various treatment modalities, STN may be positively indicated for patients with spastic pain in the lower leg.