周围神经显微减压术治疗痛性糖尿病周围神经病变

Microsurgical peripheral nerve decompression for the treatment of painful diabetic peripheral neuropathy

目的探讨周围神经显微减压术治疗痛性糖尿病周围神经病变(painful diabetic peripheral neuropathy,PDPN)的临床应用及疗效。方法对2017年9月至2018年6月武汉市中心医院神经外科收治的33例PDPN患者,按DELLON术式行周围神经显微减压手术治疗。所有患者术中行神经电生理监测,术后随访0.5~1年。术前及术后0.5年均行肌电图检查及VAS疼痛评分,并对结果进行对照分析。结果PDPN患者行周围神经显微减压术后0.5年,肌电图检查所松解神经,显示所检测神经感觉传导速度(SNCV)较术前明显增快(P<0.05)。术后VAS评分(4.6±1.8)分,较术前(8.3±2.6)明显减低(P<0.05)。结论周围神经显微减压术对PDPN有良好治疗效果,术中电生理监测可有效避免医源性神经损伤。神经电生理检查,可作为明确诊断及评价手术疗效的客观依据。

Objective To investigate the clinical application and efficacy of microsurgical peripheral nerve decompression in the treatment of painful diabetic peripheral neuropathy(PDPN).Methods From Sep.2017 to Jun.2018,33 PDPN patients of our department were treated with DELLON microsurgical peripheral nerve decompression.All surgeries were assisted with neuroelectrophysiological monitoring during the operation and were followed up for 0.5 to 1 years.Electromyography and VAS pain scores were performed 0.5 years before and after surgery,and the preoperative and postoperative results were compared.Results Postoperative electromyography showed that sensory nerve conduction velocity(SNCV)was significantly improved compared with preoperative(P<0.05),while the postoperative VAS score(4.6±1.8)was significantly lower than that(8.3±2.6)of before(P<0.05).Conclusions Microsurgical peripheral nerve decompression is an effective therapeutic method for PDPN.Intraoperative electrophysiological monitoring can effectively avoid iatrogenic nerve injury.Neurophysiological examination can be used as an objective evidence for definitive diagnosis and evaluation of surgical outcomes.