四联神经减压术治疗下肢痛性糖尿病性周围神经病的疗效分析  

Efficacy analysis of quadruple nerve decompression in the treatment of painful diabetic peripheral neuropathy of lower extremity

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12期1212-1216,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研究项目(2022-NHLHCRF-YS-05)。

摘　　要：目的探讨四联神经减压术治疗下肢痛性糖尿病性周围神经病的疗效。方法回顾性分析中日友好医院神经外科于2020年1—12月行四联神经减压术(腓管腓总神经、足背腓深神经、小腿前下1/3腓浅神经、内踝胫后神经及其分支)治疗的24例(40侧)下肢痛性糖尿病性周围神经病患者的临床资料。出院后每3个月对患者进行随访,随访内容包括评估视觉模拟评分量表(VAS)、两点辨别觉(TPD)、感觉神经传导速度(SCV)以及多伦多临床神经病变评分(TCSS),通过对比术前指标与术后随访结果评估手术疗效。结果所有患者均顺利完成手术,术后无相关并发症发生。24例患者的随访时间为(28.5±8.7)个月(14~44个月)。至末次随访,与术前比较,40侧下肢VAS评分[(1.85±1.23)分对比(6.53±1.13)分]、TPD测量结果[(7.48±2.35)mm对比(13.00±3.16)mm]、腓总神经的SCV[(42.13±2.97)m/s对比(35.75±3.28)m/s]和胫后神经的SCV[(42.07±2.75)m/s对比(35.02±3.03)m/s]均改善,差异均具有统计学意义(均P<0.001)。TCSS评估结果显示,24例患者术前均为重度糖尿病性周围神经病,末次随访时2例重度,15例中度,7例轻度;末次随访时TCSS较术前改善[(9.42±1.53)分对比(13.88±1.08)分,P<0.001]。结论四联神经减压术可改善下肢痛性糖尿病性周围神经病患者的疼痛症状和神经功能,是治疗下肢痛性糖尿病性周围神经病的有效方法。ObjectiveTo investigate the effect of quadruple nerve decompression in the treatment of painful diabetic peripheral neuropathy of lower extremity.MethodsThe clinical data of 24 patients(40 sides)with painful diabetic peripheral neuropathy of lower extremities were retrospectively analyzed in the Department of Neurosurgery at China-Japan Friendship Hospital from January 2020 to December 2020.Those patients underwent quadrilateral decompression surgery on their peripheral nerves,including the common peroneal nerve of the peroneal canal,deep peroneal nerve of the dorsal foot,superficial peroneal nerve of the anterior lower leg 1/3,and medial ankle posterior tibial nerve and its branches.All patients were followed up every three months after discharge for evaluation using Visual Analogue Scale(VAS),two-point discernability(TPD),sensory nerve conduction velocity(SCV),and Toronto Clinical Neuropathy Score(TCSS).Preoperative and postoperative comparisons were performed to evaluate the surgical efficacy.ResultsAll patients successfully underwent the operations.No postoperative complications occurred.The 24 patients were followed up for 28.5±8.7 months(14-44 months).Up to the last follow-up,compared with those before surgery,postoperative VAS score of 40 sides(1.85±1.23 points vs.6.53±1.13 points),TPD measurement results(7.48±2.35 mm vs.13.00±3.16 mm),SCV of common peroneal nerve(CPN)(42.13±2.97 m/s vs.35.75±3.28 m/s)and SCV of posterior tibial nerve(PTN)(42.07±2.75 m/s vs.35.02±3.03 m/s)were improved,and the differences were statistically significant(all P<0.001).The results of TCSS showed that all 24 patients had severe diabetic peripheral neuropathy before surgery,2 had severe,15 had moderate,and 7 had mild diabetic peripheral neuropathy after surgery.Postoperative TCSS was significantly improved compared with preoperative TCSS(9.42±1.53 points vs.13.88±1.08 points,P<0.001).ConclusionsQuadruple decompression of peripheral nerve can improve the pain symptoms and nerve function of patients with painful diabeti

关 键 词：周围神经系统疾病 糖尿病神经病变 下肢 减压术 外科 治疗结果 四联神经减压术 

分 类 号：R651.3[医药卫生—外科学]