下肢Dellon三联神经减压术治疗早期糖尿病Charcot足临床疗效

Effectiveness of lower extremity Dellon triple nerve decompression in treatment of early-stage diabetic Charcot foot

目的探讨应用下肢Dellon三联神经减压术治疗早期糖尿病Charcot足的临床疗效。方法回顾分析2017年9月—2019年2月收治的24例Eichenholtz 0~1期糖尿病Charcot足患者临床资料。其中14例行下肢Dellon三联神经减压术治疗(治疗组),10例行患肢制动、口服营养神经药物等保守治疗(对照组)。两组患者性别、年龄、糖尿病病程、糖尿病足病程、Eichenholtz分期以及治疗前血糖水平、骨密度(T值)、各神经传导速度、足底两点辨别觉等一般资料比较差异均无统计学意义(P>0.05),具有可比性。治疗前及治疗后6个月,两组采用双能X线吸收检测法测定患足骨密度(T值),评价患足骨质疏松改善情况;行下肢神经电生理检测腓总神经、腓深神经、胫神经传导速度,评价神经功能恢复情况;行足底两点辨别觉检测,评价皮肤感觉恢复情况。结果两组患者均获随访,随访时间6~12个月,平均6.5个月。治疗组3例患者手术切口周围出现麻木症状,均在12个月后自行恢复,不影响预后。治疗组14例患者手术切口均Ⅰ期愈合,未出现切口感染、不愈合及血管神经损伤等并发症。治疗后6个月,对照组各神经传导速度、骨密度T值及足底两点辨别觉与治疗前比较差异均无统计学意义(P>0.05);而治疗组上述指标均较治疗前显著改善,且均优于对照组,差异有统计学意义(P<0.05)。结论下肢Dellon三联神经减压术可以改善Eichenholtz 0~1期糖尿病Charcot足症状,具有创伤小、恢复快、并发症少等优点。

Objective To study the effectivenss of lower extremity Dellon triple nerve decompression in the treatment of early-stage diabetic Charcot foot.Methods The clinical data of 24 patients with Eichenholtz stage 0-1 diabetic Charcot foot who were admitted between September 2017 and February 2019 were retrospectively analyzed.Among them,14 cases were treated with lower extremity Dellon triple nerve decompression(treatment group),and 10 cases were treated with conservative treatment such as immobilization the affected limbs and nutritional nerve drugs(control group).There was no significant difference between the two groups(P>0.05)in gender,age,diabetes duration,diabetic foot duration,Eichenholtz stage,and the blood glucose level,bone mineral density(T value),nerve conduction velocity,and two-point discrimination before treatment.Before treatment and at 6 months after treatment,bone mineral density(T value)was measured by dual energy X-ray absorptiometry to evaluate the improvement of osteoporosis.The electromyogram of the lower limbs was used to detect the conduction velocity of the common peroneal nerve,deep peroneal nerve,and tibial nerve,and to evaluate the recovery of nerve function.The two-point discrimination in plantar region was used to evaluate the recovery of skin sensation.Results Both groups were followed up 6-12 months,with an average of 6.5 months.In the treatment group,3 patients showed numbness around the incisions,all recovered after 12 months,without affecting the prognosis;all the incisions healed by first intention,and there was no complication such as incision infection,nonunion,or vascular and nerve injury.At 6 months after treatment,there was no significant difference in nerve conduction velocity,bone mineral density(T value),and two-point discrimination when compared with the values before treatment(P>0.05)in the control group;but the above indicators in the treatment group were significantly improved when compared with preoperative ones,and were all significantly better than those in control group(P<0.05).Conclusion Lower extremity Dellon triple nerve decompression can improve the symptoms of Eichenholtz stage 0-1 diabetes Charcot foot,and has the advantages of less trauma,faster recovery,and fewer complications.