Diabetic peripheral neuropathy is the most common chronic complication of diabetes mellitus and is a group of peripheral neuropathies with sensory and autonomic symptoms as the main clinical manifestations. Motor nerve symptoms are less severe. Together with diabetic nephropathy and diabetic retinopathy, it constitutes the diabetic triad and seriously affects the quality of life of diabetic patients. So, what are the common questions that patients with diabetic peripheral neuropathy encounter? The following is a list of frequently asked questions about diabetic peripheral neuropathy.
I. What is diabetic peripheral neuropathy?
Diabetic peripheral neuropathy is the most common complication of diabetes, with an incidence of up to 60% or more in diabetic patients. More than 50% of diabetic patients with a history of more than 20 years will develop peripheral neuropathy. The main manifestations are symmetrical pain, numbness, loss of pain and temperature sensation or even absence of pain and warmth at the end of the limbs, dry and thickened skin, muscle weakness and muscle atrophy, including the typical “glove and sock-like” sensory impairment, generally heavier in the lower limbs than in the upper limbs.
Second, what are the clinical manifestations of diabetic upper limb peripheral neuropathy?
1, numbness of fingers, fingertips, palms, with electric shock, hypesthesia.
2, glove-like sensory disorder.
3, pain in fingers and fingertips, aggravated at night.
4. Clumsiness of the hand and deterioration of fine movements.
5.Atrophy of hand muscles and weakening of strength.
6.The skin of the hand is less sweaty, dry, rough and thickened.
7.Wound healing ability of the hand becomes poor.
What are the clinical manifestations of diabetic peripheral neuropathy of the lower limbs?
1.Numbness in the front and outside of the lower leg, dorsum of the foot, toes and sole of the foot, with electric shock sensation and hyperalgesia.
2.Decreased foot pain and temperature sensation.
3, sock-like sensory disorder.
4.Pain in the front and outside of the lower leg, dorsum of the foot, toes, sole and heel, aggravated at night.
5.The foot becomes clumsy and the fine movements become worse.
6.Pedal sensation to the road becomes poor, balance becomes poor, easy to fall down.
7, foot muscle atrophy, weakening strength.
8.The skin of the foot is less sweaty, dry, rough and thickened.
9, foot wound healing ability becomes poor.
10.Foot ulcers that are difficult to heal.
Fourth, how to confirm the diagnosis of diabetic peripheral neuropathy?
1.Diabetes mellitus is diagnosed.
2.There are clinical manifestations such as numbness, pain and weakness in hands and feet.
3.There are positive signs on neurological examination.
4.The upper limb median nerve, ulnar nerve, lower limb common peroneal nerve, posterior tibial nerve electromyography abnormalities.
5.Exclude serious arteriovenous lesions of the extremities.
6.Exclude serious cervical spondylosis and lumbar spondylosis.
7. Exclude other causes: alcoholism, radiation damage, heavy metal poisoning, cancer, vitamin deficiency, uremia, etc.
V. What is the current status of treatment of diabetic peripheral neuropathy?
It is generally believed that diabetic peripheral neuropathy is slowly progressive, irreversible and difficult to prevent and treat. Internal treatment is based on blood glucose control, symptomatic treatment (analgesic drugs, carbamazepine, phenytoin sodium, etc.) and nerve nutrition, etc. There is no specific and effective treatment. There is no effective treatment for limb sensory loss, but only the avoidance of soft tissue damage to avoid chain of serious consequences. In the United States, it is estimated that 27% of the cost of diabetes treatment is spent directly on the prevention and treatment of diabetic peripheral neuropathy. With a large population base and many diabetic patients in China, this huge cost is bound to place a heavy burden on the patient’s family and society.
Sixth, what are the main hazards of diabetic peripheral neuropathy to harm?
Numbness and pain in the limbs can seriously affect the quality of life of patients. Severe pain can even lead to sleepless nights and pain. Limb sensory loss can directly lead to limb infections, ulcers and amputations unrelated to diabetic vasculopathy. 15% of diabetic patients will experience progressive irreversible foot sensory loss, which is the natural course of their disease. Not only can loss of foot sensation lead to loss of balance, falls and injuries, and even fractures, but loss of superficial sensation, especially pain, is particularly important in the development of foot infections, ulcers, and amputations. The annual incidence of limb ulcers in diabetic patients is 2.5%, and the incidence of recurrent ulcers after an existing ulcer has healed is as high as 70%. 80-85% of amputations in diabetic patients are due to difficult-to-heal ulcers caused by diabetic peripheral neuropathy. Unfortunately, to date, conservative medical treatment is considered unable to stop the progression of diabetic peripheral neuropathy and only provides temporary relief of symptoms.
New insights into the etiology of diabetic peripheral neuropathy
The specific pathogenesis of diabetic peripheral neuropathy is still inconclusive. It is generally believed to be the result of vascular, metabolic, biomechanical and other multifactorial effects. Recent medical studies have shown that in the wrist, elbow, lateral knee, inner ankle, dorsal foot and other limb anatomical and physiological stenosis, the peripheral nerves (such as the median nerve, ulnar nerve, common peroneal nerve and posterior tibial nerve of the upper limb), which are swollen due to diabetic metabolic and vascular abnormalities, are compressed by the surrounding connective tissue with reduced elasticity, leading to the aggravation of neuropathy and the formation of a vicious circle is an important factor in diabetic peripheral neuropathy. This is an important causative factor for diabetic peripheral neuropathy. This theory brings hope for a new microscopic neurosurgical method to treat diabetic peripheral neuropathy.
New ways of treatment for diabetic peripheral neuropathy
The idea that peripheral nerve compression at anatomical and physiological stenosis of the limb is an important causative factor of diabetic peripheral neuropathy has been taken seriously by surgeons. Professor Dellon of the Department of Neurosurgery at Hopkins University School of Medicine was the first to suggest that peripheral nerve decompression could be used to treat diabetic peripheral neuropathy in 1988 and was confirmed in animal studies. Since 1992, Professor Dellon has performed more than 4,000 procedures for the treatment of diabetic peripheral neuropathy using peripheral nerve microdecompression. More than 40,000 patients have been treated with this procedure worldwide.
How is peripheral nerve microdecompression performed?
The surgical incisions in the lower extremities are located on the lateral knee, medial ankle and dorsum of the foot and are performed under lumbar anesthesia, while the surgical incisions in the upper extremities are located at the wrist and elbow and are performed under local anesthesia. Each incision is only a few centimeters long. Microdecompression is performed by microscopically releasing connective tissue such as muscles, tendons, and ligaments from the peripheral nerves of the wrist, elbow, lateral knee, medial ankle, and dorsal foot to improve symptoms such as numbness and pain in the limbs. The procedure has a short time. Less bleeding, less complications, less pain, quicker results, etc.
X. Surgical results of peripheral nerve microdecompression
Overall, more than 85% of patients had significant relief of symptoms after surgery. The overall efficiency of nerve decompression for plantar sensory disorders and foot pain is 80%, and surgery seems to be more effective in relieving pain. Data on median carpal tunnel nerve decompression show that the rate of relief of upper extremity sensory disorders is up to 100%. The same data showed that the rate of relief of upper extremity sensory disorders after elbow canal ulnar nerve decompression was up to 99%, with 95% of cases recovering useful two-point discrimination, but the recovery of motor function was slightly worse, with only 55% of patients recovering normal grip function of the hand. The superior efficacy of upper extremity surgery over lower extremity surgery may be due to the fact that patients with neuropathy in the upper extremity (hand) often seek medical attention earlier, and the earlier the surgery, the better the outcome. The restoration of sensation in the plantar aspect of the foot improves balance and prevents falls, thereby reducing the incidence of fractures associated with them. Lower extremity peripheral nerve decompression can alter the natural course of diabetic peripheral neuropathy, and the restoration of sensation in the lower extremity can effectively prevent ulcers and amputations. This new microscopic neurosurgery method will surely relieve the pain and bring hope to more patients with diabetic peripheral neuropathy.
XI. Possible side effects and complications of peripheral nerve microdecompression surgery
1.Wound healing delay and infection 10%.
2.Insignificant symptom relief 10%.
3.Symptom recurrence 5-10%.
What kind of patients with diabetic peripheral neuropathy are suitable for surgical treatment
The most suitable candidates for peripheral nerve microdecompression are diabetic patients who start to feel numbness and tingling in the hands and feet, cannot maintain balance when walking or cannot control certain muscle movements in the hands and feet. If the patient feels numbness and pain in the limbs all day long or if the muscle weakness and clumsiness has interfered with daily activities, and if other diseases causing numbness and pain in the limbs are ruled out, then surgery may be considered. Of course, it is necessary to confirm that the patient is medically stable, has good glycemic control, normal peripheral vascular condition, and no edema in the limbs before surgery. Surgery should be performed as early as possible before the onset of superficial sensory loss or ulcer formation. The earlier the surgery, the more obvious the improvement in symptoms and the higher the success rate. Of course, if there is an existing ulcer or a previous amputation (toe) does not mean that the opportunity for surgery is completely lost, and an experienced neurosurgeon should be consulted.
XIII. Questions about the surgical cost and time of peripheral nerve microdecompression
Operation time total hospitalization cost hospitalization time
1.Microscopic decompression of the median nerve in the carpal tunnel of the upper limb 45 minutes 7000 yuan 10 days.
2.Microscopic decompression of the ulnar nerve in the elbow canal of the upper limb 60 minutes 8,000 yuan 12 days.
3.Microscopic decompression of median nerve of upper limb carpal tunnel and ulnar nerve of elbow tunnel 90 minutes 10,000 RMB for 12 days.
4.Lateral common peroneal nerve microdecompression of lower limb 45 minutes 6000 RMB 10 days.
5.Microscopic decompression of the posterior tibial nerve in the lower limb of the inner ankle 60 minutes 8000 RMB for 12 days.
6.Microscopic decompression of the deep peroneal nerve in the dorsal foot of the lower extremity 30 minutes 6000 RMB for 10 days.
7.Microscopic decompression of the common peroneal nerve, posterior tibial nerve and deep peroneal nerve of the lower extremity 90 minutes 10,000 yuan for 12 days.
XIV. Preparations needed before coming to Beijing for surgery
1.Stable internal medical condition.
2.Good blood sugar control.
3.No edema in the limb.
4.Electromyography results of median nerve, ulnar nerve of upper limb, common peroneal nerve and posterior tibial nerve of lower limb.
5. Ultrasound results of arteriovenous vessels of the extremities.
6. Imaging results of cervical and lumbar spine.