Tinel 征的有效性和糖尿病与非糖尿病患者踝管内胫神经受压的患病率：一项横断面研究。

Validity of the Tinel Sign and Prevalence of Tibial Nerve Entrapment at the Tarsal Tunnel in Both Diabetic and Nondiabetic Subjects: A Cross-Sectional Study.

机构信息

From the Department of Plastic-, Reconstructive- and Hand Surgery, Erasmus University Medical Center; the Department of Plastic-, Reconstructive- and Hand Surgery, the Department of Internal Medicine/Centre for Diabetes, and the Department of Statistics and Education, Franciscus Gasthuis & Vlietland; the Xpert Clinic, Hand and Wrist Surgery; and the Departments of Obstetrics and Gynecology and Plastic-, Reconstructive- and Hand Surgery, Utrecht Medical University Center, Utrecht University.

出版信息

Plast Reconstr Surg. 2018 Nov;142(5):1258-1266. doi: 10.1097/PRS.0000000000004839.

DOI:10.1097/PRS.0000000000004839

PMID:30113445

Abstract

BACKGROUND

Nerve entrapments like carpal tunnel syndrome are more prevalent in patients with diabetes, especially in those with diabetic polyneuropathy. Our study aims were to investigate the validity of the Tinel sign in diagnosing tibial neuropathy and determine the prevalence of tibial nerve entrapment in both a diabetic and nondiabetic population.

METHODS

Two hundred forty nonneuropathic subjects with diabetes and 176 diabetic subjects with neuropathy participating in the prospective Rotterdam Diabetic Foot Study and 196 reference subjects without diabetes and without neuropathy complaints were evaluated. All subjects underwent sensory testing of the feet, and complaints were assessed using the Michigan Neuropathy Screening Instrument. The Tinel sign was defined as discriminative and valid for diagnosing tibial nerve entrapment when the nerve-related Michigan Neuropathy Screening Instrument subscore of neuropathic symptoms differed at least 5 percent between the Tinel-positive and Tinel-negative subjects. When the sign was valid, prevalence estimates of tibial nerve entrapment at the tarsal tunnel were calculated.

RESULTS

Significantly more neuropathic symptoms (p < 0.002) and higher sensory thresholds (p < 0.0005) were observed in (compressed) tibial nerve-innervated areas, indicating that a positive Tinel sign at the tarsal tunnel is a valid measure of tibial nerve abnormality. The prevalence of tibial nerve entrapment in diabetic patients was 44.9 percent (95 percent CI, 40.1 to 49.7 percent) versus 26.5 percent (95 percent CI, 20.3 to 32.7 percent) in healthy controls (p < 0.0001).

CONCLUSIONS

Tibial nerve entrapment is more prevalent in diabetic subjects than in controls. The significantly more frequently reported neuropathic complaints and concomitant sensory disturbances provide evidence for the role of superimposed entrapment neuropathy in diabetes-related neuropathy.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

摘要

背景

神经卡压症，如腕管综合征，在糖尿病患者中更为常见，尤其是在合并有糖尿病多发性神经病的患者中。我们的研究旨在探讨 Tinel 征诊断胫骨神经病的有效性，并确定糖尿病患者和非糖尿病患者中胫骨神经卡压的患病率。

方法

前瞻性的鹿特丹糖尿病足研究纳入了 240 例非神经病变的糖尿病患者和 176 例伴有神经病变的糖尿病患者，以及 196 例无糖尿病且无神经病变症状的参考患者。所有患者均进行了足部感觉测试，并使用密歇根神经病变筛查工具评估了症状。Tinel 征被定义为当神经相关的密歇根神经病变筛查工具神经病变症状亚评分在 Tinel 征阳性和 Tinel 征阴性患者之间至少相差 5%时，对诊断胫骨神经卡压具有区分性和有效性。当该征象有效时，计算踝管内胫骨神经受压的患病率。

结果

在（受压的）胫骨神经支配区域，观察到明显更多的神经病变症状（p<0.002）和更高的感觉阈值（p<0.0005），表明踝管处的 Tinel 征阳性是胫骨神经异常的有效测量指标。糖尿病患者的胫骨神经卡压患病率为 44.9%（95%可信区间，40.1%至 49.7%），而健康对照者为 26.5%（95%可信区间，20.3%至 32.7%）（p<0.0001）。