Tu Yiji, Lineaweaver William Charles, Chen Zenggan, Hu Junda, Mullins Fred, Zhang Feng
Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Joseph M. Still Burn and Reconstruction Center, Jackson, Mississippi.
J Reconstr Microsurg. 2017 Mar;33(3):151-157. doi: 10.1055/s-0036-1594300. Epub 2016 Nov 28.
Over the last decade, surgical decompression procedures have been commonly used in the treatment of diabetic peripheral neuropathy. However, the effectiveness of them remains to be proved. A comprehensive literature search of databases including PubMed-Medline, Ovid-EMBASE, and Cochrane Library was performed to collect the related literatures. The Medical Subject Headings used were "diabetic neuropathy," "surgical decompression," and "outcomes." The methodological index for nonrandomized studies was adopted for assessing the studies included in this review. Analyses were performed with Review Manager (Version 5.3, Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2014). A total of 12 literatures (including 8 prospective and 4 retrospective) encompassing 1,825 patients with DPN were included in the final analysis. Only one literature was identified as a randomized controlled trial. The remaining 11 literatures were observational studies; 7 of them were classified as upper-extremity nerve decompression group and 4 of them were classified as lower-extremity nerve decompression group. Meta-analysis shows that Boston questionnaire symptom severity and functional status of upper extremities, and distal motor latency and sensory conduction velocity of median nerve of DPN patients are significantly improved after carpal tunnel release. Besides, visual analog scale and two-point discrimination are considered clinically and statistically significant in lower extremities after operation. The findings from our review have shown the efficacy of surgical decompression procedures in relieving the neurologic symptoms and restoring the sensory deficits in DPN patients. As there are few high-quality randomized controlled trials or well-designed prospective studies, more data are needed to elucidate the role of surgical procedures for DPN treatment in the future.
在过去十年中，手术减压程序已被广泛用于治疗糖尿病周围神经病变。然而，其有效性仍有待证实。我们对包括PubMed-Medline、Ovid-EMBASE和Cochrane图书馆在内的数据库进行了全面的文献检索，以收集相关文献。使用的医学主题词为“糖尿病神经病变”“手术减压”和“结果”。采用非随机研究的方法学指标来评估本综述纳入的研究。使用Review Manager（版本5.3，哥本哈根：北欧Cochrane中心，Cochrane协作网，2014年）进行分析。最终分析纳入了12篇文献（包括8篇前瞻性文献和4篇回顾性文献），共1825例糖尿病周围神经病变患者。仅一篇文献被确定为随机对照试验。其余11篇文献为观察性研究；其中7篇归类为上肢神经减压组，4篇归类为下肢神经减压组。荟萃分析表明，腕管松解术后，糖尿病周围神经病变患者的波士顿问卷症状严重程度和上肢功能状态，以及正中神经的远端运动潜伏期和感觉传导速度均有显著改善。此外，术后下肢的视觉模拟评分和两点辨别觉在临床和统计学上均具有显著意义。我们综述的结果表明，手术减压程序在缓解糖尿病周围神经病变患者的神经症状和恢复感觉功能障碍方面具有疗效。由于高质量的随机对照试验或设计良好的前瞻性研究较少，未来需要更多数据来阐明手术治疗糖尿病周围神经病变的作用。
