周围神经显微减压术治疗下肢透析相关周围神经病的疗效  

Microsurgical decompression of peripheral nerves for treatment of dialysis-related peripheral neuropathy of lower limbs

作　　者：杨文强[1] 王琦[1] 李爱民[1] 于炎冰[1] 张黎[1] Yang Wenqiang;Wang Qi;Li Aimin;Yu Yanbing;Zhang Li(Department of Neurosurgery,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院神经外科,北京100029

出　　处：《中华神经外科杂志》2024年第10期1038-1042,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81973628);中日友好医院高水平医院临床业务费专项研究项目(2022-NHLHCRF-YS-05)。

摘　　要：目的探讨周围神经显微减压术治疗下肢透析相关周围神经病(DRPN)的疗效。方法回顾性分析2018年1月至2022年12月中日友好医院神经外科手术治疗的21例下肢DRPN患者的临床资料。21例患者共42侧患肢,均采用腓总神经(CPN)、胫后神经(PTN)及其三个分支的显微神经减压术。出院后对所有患者进行随访,随访内容包括记录患者麻木、疼痛症状缓解情况和复查肌电图,以评估疗效。结果21例患者手术均顺利完成。21例患者随访时间为(22.5±9.9)个月(12~48个月)。至末次随访,肌电图复查结果显示:CPN感觉神经传导速度[(42.2±3.7)m/s]和动作电位波幅[(9.2±1.5)mV]较术前[分别为(33.2±4.1)m/s、(5.8±1.1)mV]均增加(均P<0.05),运动神经传导速度[(44.2±3.1)m/s]和动作电位波幅[(9.1±1.6)mV]较术前[分别为(37.0±3.9)m/s、(6.4±1.3)mV]均增加(均P<0.05)。PTN感觉神经传导速度[(43.3±2.8)m/s]和动作电位波幅[(9.1±1.6)mV]较术前[分别为(34.1±4.5)m/s、(6.3±1.2)mV]均增加(均P<0.05),运动神经传导速度[(43.0±3.2)m/s]和动作电位波幅[(8.7±1.7)mV]较术前[分别为(36.7±4.8)m/s、(6.8±1.3)mV]均增加(均P<0.05)。至末次随访,21例患者36侧(85.7%)的下肢麻木获得改善,42侧(100.0%)的下肢疼痛获得改善,38侧(90.5%)患肢的运动功能得到改善。结论周围神经显微减压术可有效提高下肢DRPN患者下肢神经传导速度和动作电位、缓解其肢体症状,是治疗下肢DRPN的有效方法。ObjectiveTo investigate the efficacy of microsurgical decompression of peripheral nerves in the treatment of lower limb dialysis-associated peripheral neuropathy(DRPN)in the lower limbs.MethodsThe clinical data of 21 patients with DRPN in their lower limbs,who were admitted to the Department of Neurosurgery of China-Japan Friendship Hospital from January 2018 to December 2022,were retrospectively analyzed.Microsurgical decompression was performed on the common peroneal nerve(CPN),posterior tibial nerve(PTN)and its three branches in all 21 patients with a total of 42 affected limbs.All patients were followed up after discharge,which included recording their symptom relief and review of EMG(electromyography)to assess the efficacy.ResultsAll 21 cases underwent successful operations.The mean follow-up time for these patients was 22.5±9.9 months(range:12 to 48 months).Up to the last follow-up,the results of EMG review showed that compared with preoperative values,there was a significant increase of CPN in the sensory nerve conduction velocity(42.2±3.7 m/s vs.33.2±4.1 m/s)and action potential amplitude(9.2±1.5 mV vs.5.8±1.1 mV),as well as the motor nerve conduction velocity(44.2±3.1 m/s vs.37.0±3.9 m/s)and action potential amplitude(9.1±l.6 mV vs.6.4±1.3 mV)(all P<0.05).PTN also exhibited an increase in the sensory nerve conduction velocity from(43.3±2.8 m/s vs.34.1±4.5 m/s)and action potential amplitude(9.1±1.6 mV vs.6.3±1.2 mV),as well as the motor nerve conduction velocity(43.0±3.2 m/s vs.36.7±4.8 m/s)and action potential amplitude(8.7±1.7 mV vs.6.8±1.3 mV)(all P<0.05).Up to the last follow-up,numbness on 36 sides(85.7%)of the affected limb was relieved in 21 patients,pain symptoms on 42 sides(100.0%)were relieved,and motor function of the affected limb on 38 sides(90.5%)was relieved.ConclusionsMicrosurgical decompression of the peripheral nerve can effectively improve the nerve conduction velocity and action potential amplitude of lower limb NRPN pationts,and alleviate their limb symptoms.So it is

关 键 词：周围神经系统疾病 透析 下肢 周围神经 显微减压术 

分 类 号：R651.3[医药卫生—外科学]