摘要目的 探讨高频超声、神经电生理在糖尿病性周围神经病( DPN)早期诊断及其神经减压手术时机、疗效评估中的应用价值.方法 对560例糖尿病性下肢周围神经病患者,按Dellon术式对卡压神经进行显微松解术.所有病例术前、术后1.5年进行多伦多临床神经病变评分(TCSS),神经高频超声、定量感觉功能(QST)、神经感觉传导速度(NCV)检测,并在相应时间节点采用同样指标与健康对照组进行对比.结果 DPN患者高频超声显示受累神经肿胀、增粗,内部回声减低,神经内线状结构消失,神经前后径(D1)和横径(D2),横断面积( CSA)手术前后差异有统计学意义(P＜0.01).NCV阳性检测率为74.9％,QST阳性检测率为90.9％,两者差异有统计学意义.DPN早期诊断QST较NCV更为敏感.NCV术后较术前明显增快(P＜0.05),冷感觉阈值较术前明显升高(P＜0.05)；热感觉阈值较术前明显降低(P＜0.01)；振动觉阈值较术前明显降低(P＜0.05).NCV与冷感觉阈值呈正相关；与热感觉阈值、振动觉阈值呈负相关.术前TCSS评分19分者术后75％改善至10 ～ 13分(P＜0.01).结论 高频超声能够从形态学角度提供神经卡压程度、部位等信息.QST检测适用于DPN的早期诊断,QST异常是实施下肢神经减压术的适应证.QST与NCV两者联合使用对把握手术时机具有重要意义,高频超声、NCV、QST可作为评价手术疗效的客观依据.

abstractsObjective To evaluate the clinical value of high - resolution ultrasound and electrophysiology in the low extremity nerve decompression for diabetic peripheral neuropathy.Method In this study,560 diabetic peripheral neuropathy (DPN) patients were treated with Dellon surgical nerve decompression.Before and 1.5 years after surgery,the tests of Toronto clinical scoring system (TCSS),High- resolution ultrasound,quantitative sensory testing (QST) and nerve conduction velocity (NCV) were performed in all cases,and these data were compared to the normal control.Results Ultrasonographic images revealed an apparently normal proximal nerve marked swelling,enlarged and hypoechogeneity with loss fascicular pattern.The cross - sectional - area,anteroposterior dimension and transverse diameter were measured by preoperative and preoperative,and the differences had statistical significance( P ＜ 0.01 ).NCV- positive cases amounted to 74.9％ DPN patients in this study,and QST - positive cases amounted to 90.9％.There were significant differences between NCV and QST results ( P ＜0.05),therefore,QST was more sensitive to early stage diabetic peripheral neuropathy patients than NCV.Postoperative NCV significantly increased ( P ＜ 0.05 ) compared with that before surgery.Postoperative cold perception threshold (CPT) significantly increased compared with the preoperative value ( P ＜ 0.05 ).Postoperative warm perception threshold (WPT) was significantly lower than the preoperative value (P ＜0.01).Postoperative vibration perception threshold (VPT) was significantly lower than the preoperative value ( P ＜ 0.05 ).NCV was positively correlated with CPT,and negatively correlated with WPT and VPT.The preoperative TCSS score was 19 points for all the cases,and 420 cases (75％) improved to 10 ～ 13 points ( P ＜ 0.01 ).Conclusion Ultrasonography can be capable of depicting these nerves morphological imformation,with respect to exact location,course,extent.QST is suitable for early diagnosis of DPN.Abnormal QST is an indication of lower extremity nerve decompression for DPN.The joint use of QST and NCV testing helps surgeons to grasp the timing of surgery.High- resolution ultrasound,QST and NCV testing can also be used as an outcome index for surgical treatment.