Siemionow Maria, Zielinski Maciej, Sari Alper
Department of Plastic Surgery of The Cleveland Clinic Foundation, Ohio, 44195, USA.
Ann Plast Surg. 2006 Jul;57(1):41-9. doi: 10.1097/01.sap.0000210634.98344.47.
Diabetic patients are more susceptible to the development of entrapment neuropathy than nondiabetics. Since these patients suffer from a slowly progressing diabetic polyneuropathy, standard neurosensory and motor tests of nerve function are not sufficient in the diagnosis of superimposed nerve compression. This is most evident in the early stages of compression when quantitative diagnosis is important for making decisions on surgical decompression. We evaluated the validity of computer-assisted pressure-specified sensory device (PSSD) testing in the early detection of superimposed entrapment in diabetic neuropathy in comparison with standard clinical tests. Twenty-five diabetic patients with complaints of peripheral nerve dysfunction were evaluated by clinical tests and PSSD. Out of those, nerve entrapment was detected in 15 patients (60%) (9 in late and 6 in early stage) by neurosensory PSSD testing. Standard clinical tests were confirmative in 33.3% of these cases (44% of late and 16.7% of early stage). Out of 144 evaluated nerves, 50 were diagnosed with entrapment (24 in late and 26 in early stage) using PSSD. Clinically, diagnosis was confirmed in 16% of entrapped nerves (20.8% of late and 11.5% of early stage). Average diabetes duration in patients with entrapment diagnosed using PSSD was significantly shorter than for those diagnosed clinically (4.14 +/- 2.04 vs. 7.2 +/- 1.3, respectively; P = 0.005). Among evaluated factors, mean age and diabetes duration were found to be significantly shorter in patients with entrapment than in those with advanced diffused changes (54.47 +/- 13.07 vs. 67.10 +/- 14.2; P = 0.019 and 5.33 +/- 3.74 vs.14.22 +/- 8.17; P = 0.006; respectively). Our results revealed higher sensitivity of PSSD in comparison with standard clinical tests in the detection of early-stage entrapment in patients with diabetes. To assess accuracy of PSSD in the proper patients' qualification for surgery, further prospective, postoperative studies are needed.
糖尿病患者比非糖尿病患者更容易发生卡压性神经病。由于这些患者患有缓慢进展的糖尿病性多发性神经病，标准的神经感觉和运动功能测试不足以诊断叠加的神经受压。这在压迫的早期阶段最为明显，此时定量诊断对于决定是否进行手术减压很重要。我们评估了计算机辅助压力特定感觉装置（PSSD）测试与标准临床测试相比，在早期检测糖尿病性神经病叠加卡压方面的有效性。对25名主诉周围神经功能障碍的糖尿病患者进行了临床测试和PSSD测试。其中，通过神经感觉PSSD测试在15名患者（60%）中检测到神经卡压（9名处于晚期，6名处于早期）。标准临床测试在这些病例中的确诊率为33.3%（晚期为44%，早期为16.7%）。在144条评估的神经中，使用PSSD诊断出50条有卡压（24条处于晚期，26条处于早期）。临床上，确诊的卡压神经占16%（晚期为20.8%，早期为11.5%）。使用PSSD诊断出有卡压的患者的平均糖尿病病程明显短于临床诊断的患者（分别为4.14±2.04年和7.2±1.3年；P = 0.005）。在评估的因素中，发现有卡压的患者的平均年龄和糖尿病病程明显短于有晚期弥漫性改变的患者（分别为54.47±13.07岁和67.10±14.2岁；P = 0.019；以及5.33±3.74年和14.22±8.17年；P = 0.006）。我们的结果显示，与标准临床测试相比，PSSD在检测糖尿病患者早期卡压方面具有更高的敏感性。为了评估PSSD在正确筛选适合手术的患者方面的准确性，还需要进一步的前瞻性术后研究。
