Microsurgical decompression of the median nerves for treating diabetic peripheral neuropathy in the upper limbs: A 21-month follow-up*

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• 作者：Peng Lin ; Li Zhang ; Yanbing Yu ; Xiaoli Xu ; Jiang Liu ; Fang Li ; Jun Xu
• 关键词：diabetic neuropathies ; peripheral nerves ; median nerve ; microsurgery
• 刊名：Neural Regeneration Research
• 出版年：2007
• 出版时间：February 2007
• 年：2007
• 卷：2
• 期：2
• 页码：103-106
• 全文大小：69 K

文摘

Peripheral nerve injured by abnormal glucose metabolism is compressed, which is an important etiological factor of diabetic peripheral neuropathy (DPN). Microsurgical decompression of peripheral nerve maybe effectively releases the symptoms of DPN.

Objective

To investigate the curative effects of microsurgical decompression of median nerves for treatment of DPN in upper limbs.

Design

Case-follow up observation.

Setting

Department of Orthopaedics, Department of Neurosurgery, China-Japan Friendship Hospital, Ministry of Health.

Participants

Twelve patients with DPN in upper limbs (19 hands) who received treatment in the Department of Orthopaedics, Department of Neurosurgery, China-Japan Friendship Hospital, Ministry of Public Health between March 2004 and July 2006 were involved in this experiment. The involved patients, 5 male and 7 female, were aged 44 to 77 years, with DPN course of 6 months to 16 years. They all met 1999 WHO diabetic diagnosis criteria. Both two hands had symptom in 7 patients, and only one hand had symptom in 5 patients. Informed consents of detected items were obtained from all the patients, who also received 21 months of follow-up treatment.

Methods

Operation was carried out under the anesthetic status of brachial plexus. Under an operating microscope, transverse carpal ligament was exposed. Subsequently, transverse carpal ligament, forearm superficial fascia and palmar aponeurosis were fully liberated, and then part of them was cut off. Connective tissue around median nerve, superficial flexor muscle of fingers, radial flexor, palmaris longus and other flexor tendons were completely loosened. Finally, epineurium was opened with microinstrument for neurolysis. After tourniquet was loosened, and bipolar coagulator was used to stop bleeding, and the incision was closed. In postoperative 21 months, the subjective symptom, two-point discrimination (The smallest distance of two normal points was 3 to 6 mm), nerve conduction velocity and action potential amplitude (short abductor muscle of thumb end Lat < 4.5 ms; Motor nerve conduction velocity of forearm > 50 m/s), etc. of all the patients were followed up.

Main outcome measures

The objective evaluation and long-term follow up of curative effect of microsurgical decompression of median nerves for treatment of DPN in upper limbs.

Results

Twelve patients with DPN in upper limbs participated in the final analysis. After operation, numbness and pain symptom releasing 100 % were found in 19 hands of 12 patients with DPN. During follow up, numbness and recrudescent pain symptom were found in one hand (5 % ,1/19). Postoperatively, index finger two point discrimination in 15 (94 % ,15/16)hands recovered to normal. 5/0?wchp=dGLbVlb-zSkWz"" alt=""Image"" align=""absbottom"" border=""0"" height=2 width=2> nerve conduction velocity and action potential amplitude improved completely. Two hands (2/19,10 % )had poor healing at incision, and they late healed at postoperative 1 and 1.5 months, respectively.

Conclusion

Long-term follow-up results show that microsurgical decompression is an effective method to treat DPN in upper limbs.