Guyon氏管减压术治疗糖尿病性周围神经病的临床应用

Role of Guyon’s canal decompression in the surgical treatment of diabetic peripheral neuropathy

目的研究Guyon氏管减压术在糖尿病性周围神经病(DPN)治疗中的价值。方法选择中日友好医院周围神经外科亚专科自2019年3月至2020年3月收治并采用显微外科手术的11例(14侧)上肢DPN患者为研究对象,其中7例为既往行肘管尺神经减压手术,均为单侧,行Guyon氏管尺神经减压术;余4例为首次手术患者,3例为双侧,1例为单侧,行肘管尺神经减压术联合Guyon氏管尺神经减压术。术后进行随访,观察患者手部麻木、疼痛等感觉功能障碍、运动功能障碍及两点辨别觉的改善情况,以评估手术疗效。结果所有患者平均随访时间为12个月。11例上肢DPN患者中,麻木症状缓解12侧(85.71%),疼痛症状缓解14侧(100%),运动障碍改善10侧(71.43%),术后小指两点辨别觉好转12侧(85.71%)。结论Guyon氏管尺神经卡压在DPN中易被忽视,临床需要给予足够重视,Guyon氏管减压术在上肢DPN中的显微外科手术中具有重要价值。

Objective To evaluate the value of Guyon’s canal decompression in the treatment of diabetic peripheral neuropathy with(DPN)microsurgery.Methods Eleven patients(14 sides)with upper extremity DPN,admitted to Neurosurgery Department of China-Japan Friendship Hospital from March 2019 to March 2020,underwent microsurgical decompression of the Guyon’s canal,7 of whom underwent unilateral ulnar nerve decompression of the cubital canal.The ulnar nerve decompression of the cubital canal and Guyon’s canal were performed in 4 patients,3 patients were bilateral and 1 patient was unilateral.Postoperative follow-up was conducted to observe the improvement of sensory dysfunction(hand numbness,pain),motor dysfunction and two-point discrimination perception.Results All patients were followed up for an average of 12 months.In 11 patients with upper extremity DPN,numbness was relieved by 85.71%(12/14),pain was relieved by 100%(14/14),dyskinesia was improved by 71.43%(10/14),and little finger discrimination was improved by 85.71%(12/14).Conclusion The ulnar nerve entrapment in the Guyon’s canal is easy to be neglected in DPN and should be paid enough attention in clinical practice.The ulnar nerve decompression in the Guyon’s canal plays an important value in upper extremity DPN.