周围神经显微减压术治疗糖尿病性下肢周围神经病

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1、周围神经显微减压术治疗糖尿病性下肢周围神经病杨文强张黎于炎冰徐晓利许骏刘江【摘要】目的探讨周围神经显微减压术治疗糖尿病性下肢周围神经病的疗效。方法应用腓总神经、腓深神经、胫后神经主干及其分支显微减压术治疗42例糖尿病性下肢周围神经病患者（54侧下肢）。结果平均随访40个月。42例糖尿病性下肢周围神经病患者54侧下肢膝下麻木、疼痛症状术后88.9%(48/54)缓解，肢体平衡问题术后70.0%(21/30)缓解，随访期间54侧下肢无一侧发生顽固性溃疡或截肢。术后拇指两点辨别觉好转40侧（74.1%，40/54），腓总神经、

2、胫后神经感觉、运动神经传导速度及动作电位波幅改善38侧（70.4%，38/54）。并发症：踝部切口愈合不良3侧（5.6%,3/54）。结论周围神经显微减压术是治疗糖尿病性下肢周围神经病的有效方法，严格把握手术指征及术中神经彻底减压是保证疗效的关键。【关键词】糖尿病性周围神经病；周围神经；显微减压手术；下肢MicrosurgicaldecompressionofperipheralnervesfortreatmentofdiabeticperipheralneuropathyoflowerlimbsYANGWen-qian

3、g，ZHANGLi，YUYan-bing，XUXiao-li,XUJun,LIUJiang.DepartmentofNeurosurgery，China-JapanFriendshipHospital，Beijing100029，China【Abstract】ObjectiveTostudytheeffectivenessofmicrosurgicaldecompressionofperipheralnervesfortreatmentofdiabeticperipheralneuropathyoflowerlimbs.

4、MethodsThemicrosurgicaldecompressionofcommonperonealnerve,deepperonealnerve,posteriortibialnerveanditsbrancheswasperformedon54lowerlimbsof42diabeticpatientswithdiabeticperipheralneuropathy(DPN).ResultsAllthepatientswerefollowed-upfor40monthsinaverage.Thesymptomso

5、fnumbnessandpainwereimprovedin48of54lowerlimbs(88.9%,48/54).70.0%ofthepatientswithpreoperativebalanceproblemswereimproved(21/30).Thetwopointsdiscriminationof40sides（74.1%，40/54）oflimbswereimproved.Theconductionvelocityandamplitudeofactionpotentialofcommonperoneal

6、nervesand/orposteriortibialnervesof38sides（70.4%，38/54）oflimbswereimprovedafterthesurgery.Therewasnorefractoryulcerationoramputationoccurredin54lowerlimbsduringfollow-upduration.Delayedwoundhealingwasfoundin3lowerlimbs(5.6%,3/54).ConclusionsMicrosurgicaldecompres

7、sionofperipheralnervesisaneffectivemethodforthetreatmentofdiabeticperipheralneuropathyoflowerlimbs.Strictpreoperativepatientselectionandcompleteintro-operativedecompressionarekeypointsforgoodpostoperativeresults.【KeyWords】Diabeticperipheralneuropathy;Peripheralne

8、rves；Microsurgicaldecompression;Lowerlimbs糖尿病性周围神经病（diabeticperipheralneuropathy，DPN）是最为常见的糖尿病性神经病变。在腕管、肘管、膝外侧腓总神经管、内踝跗管等肢体解剖生理狭窄处，由于糖尿病性代谢异常而发生病损的周围神经受到卡压是DPN