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

摘要

BACKGROUND: 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: ①Operation 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. ② 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 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. ① 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). ②Postoperatively, index finger two point discrimination in 15 (94%,15/16)hands recovered to normal. ③ nerve conduction velocity and action potential amplitude improved completely . ④ 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.