Hand and Microsurgery Center of El Paso, 10201 Gateway West Suite 301, El Paso, TX, USA; Clinical Professor, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA.
Hand and Microsurgery Center of El Paso, 10201 Gateway West Suite 301, El Paso, TX, USA.
Clin Neurol Neurosurg. 2023 Aug;231:107800. doi: 10.1016/j.clineuro.2023.107800. Epub 2023 May 24.
Carpal tunnel release outcomes in diabetic and non-diabetic patients are conflicting, possibly due to lack of differentiating patients with axonal neuropathy and those without axonal neuropathy.
Sixty-five diabetic and 106 non-diabetic patients who failed conservative treatment and then underwent carpal tunnel release from 2015 to 2022 were selected from a hand surgeon's patient database. Diagnosis was established with parameters established with the CTS-6 Evaluation Tool, and electrodiagnosis when indicated. Patient outcomes were evaluated using preoperative and postoperative Disabilities of Arm Shoulder and Hand (DASH), Brief Pain Inventory (BPI), Boston Carpal Tunnel Questionnaire, Numeric Pain Scale, and Wong-Baker Pain Scale. Postoperative evaluations were taken 6 months to a year post-surgery. Skin biopsies for nerve fiber density and morphology were taken from 50 diabetic patients. Another 50 were taken from non-diabetic patients with carpal tunnel syndrome and served as controls. Biopsy-proven axonal neuropathy was used as a confounding variable in the assessment of diabetic patients' recovery RESULTS: When comparing diabetics with biopsy-proven axonal neuropathy to diabetics without axonal neuropathy, the recovery outcomes are increasingly better for diabetics without neuropathy. Diabetics with biopsy-proven neuropathy have an improvement in recovery outcomes as well; however, not to the level of non-diabetics.
Patients with increased scale scores or clinical suspicion for axonal neuropathy can be offered the option of undergoing a biopsy, and counseled about the risks for increased time to meet outcomes comparable to non-diabetics and diabetics without axonal neuropathy.
糖尿病患者和非糖尿病患者的腕管松解术结果存在争议，这可能是由于未能区分有轴索神经病和无轴索神经病的患者。
从一名手外科医生的患者数据库中选择了 65 名糖尿病患者和 106 名非糖尿病患者，这些患者在保守治疗失败后于 2015 年至 2022 年接受了腕管松解术。通过 CTS-6 评估工具和有指征时的电诊断来确立诊断。使用术前和术后上肢残疾问卷（DASH）、简明疼痛量表（BPI）、波士顿腕管问卷、数字疼痛量表和 Wong-Baker 疼痛量表来评估患者的结果。术后评估在手术后 6 个月至 1 年进行。从 50 名糖尿病患者中取皮肤活检，用于神经纤维密度和形态的评估。从 50 名患有腕管综合征的非糖尿病患者中取另 50 名作为对照。将活检证实的轴索神经病作为评估糖尿病患者恢复情况的混杂因素。
将有活检证实的轴索神经病的糖尿病患者与无轴索神经病的糖尿病患者进行比较时，无神经病的糖尿病患者的恢复结果越来越好。有活检证实的神经病的糖尿病患者的恢复结果也有所改善，但无法达到非糖尿病患者的水平。
对于 Scale 评分较高或有轴索神经病临床怀疑的患者，可以选择进行活检，并告知其增加达到与非糖尿病患者和无轴索神经病的糖尿病患者可比结果的时间的风险。
