Carvalho Viviane Fernandes de, Ferreira Marcus Castro, Vieira Suzy Ane Tavares, Ueda Thiago
FMUSP, São Paulo, Brazil.
Rev Assoc Med Bras (1992). 2009 Jan-Feb;55(1):29-34. doi: 10.1590/s0104-42302009000100011.
Neuropathy is a severe progressive loss of protective sensation in the feet, increasing patient vulnerability to mechanical trauma and consequently more prone to development of chronic wounds, major distortion of the foot bone architecture and to eventual limb amputation. Prophylaxis should be enforced to avoid foot ulceration and for this purpose, evaluation of the degree of loss of sensation on the skin is essential. The PSSD (Pressure Specified Sensory Device) was developed to quantify the threshold of pressure applied to the skin that the patient might recognize as positive. Pressure of one or two points is tested both statically and with movement, thus assessing the function of fast and slow response nerve fibers.
33 diabetic patients, type II, with no previous history of wounds on the lower extremity were studied. The tests used were, one point static, one point moving and two points, static and moving on the cutaneous territory of the fibular nerve and posterior tibial nerve (two territories - medial plantar and calcaneous nerves).
Altered values were observed for the static and dynamic tests over the three nerve territories studied. Differences were statically significant (p < 0.05). This numeric quantification of the threshold of pressure supports the evaluation of the status of the fiber/receptor structures as well as the functional deficit subsequent to diabetic neuropathy.
神经病变是足部保护性感觉严重且进行性丧失，这增加了患者遭受机械创伤的易感性，进而更易发展为慢性伤口、足部骨骼结构严重变形以及最终的肢体截肢。应加强预防措施以避免足部溃疡，为此，评估皮肤感觉丧失程度至关重要。压力特定感觉装置（PSSD）的研发目的是量化施加于皮肤的压力阈值，该压力阈值是患者可能识别为阳性的压力。对一点或两点压力进行静态和动态测试，从而评估快速和慢速反应神经纤维的功能。
对33例无下肢伤口既往史的II型糖尿病患者进行研究。所采用的测试为在腓神经和胫后神经的皮肤区域（两个区域——足底内侧和跟骨神经）进行一点静态、一点动态以及两点静态和动态测试。
在所研究的三个神经区域，静态和动态测试均观察到数值改变。差异具有统计学意义（p < 0.05）。这种压力阈值的数值量化有助于评估纤维/感受器结构的状态以及糖尿病神经病变后的功能缺陷。
