Clinical Analysis Of Neurolysis Of Peripheral Nerve For The Treatment Of Diabetic Foot

OBJECTIVE:To realize symptoms relief of diabetic foot after neurolysis of peripheral nerve.To observe the ulcer agglutination of diabetic foot.To realize what role neurolysis play in the ulcer agglutination of diabetic foot.To confer preparatory discussion of the mechanism that neurolysis could accelerate ulcer agglutination of diabetic foot.METHODS:37 inpatients with 47 diabetic feet were enrolled from department of trauma orthopaedics and hand surgery in the first,affiliated hospital of Guangxi Medical University from May 2006 to December 2008.10 inpatients were double diabetic feet.All inpatients were distributed into two groups,one was no numb group,all of them had no numb symptoms of diabetic foot;the other was numb group,all of them had numb symptoms of diabetic foot.All inpatients accepted routinetherapy i.e.debridement,dressing change,control blood sugar,control infection and neurolysis of peripheral nerve i.e. neurolysis of common peroneai nerve at the capitulum fibulae neck and neurolysis of tibial nerve at the tarsal tunnel.All of them in two groups were defined serious degree by Wagner Grade.All inpatients were detected several items before and atter their operations,such as,foot sensation,foot pain score (visual analogue scales,VAS),ankle-brachial index(ABI),both lower extremities CT angiography(CTA),ulcer or wound agglutination time,foot ulcer pathological fanding when performing the operation.Follow-up visit recurrence rate and amputation rate.Compare with two group's results.RESULTS:Two inpatients failured to be visited in all 37 cases.Follow-up visit time range was from 3 months to 31 months,average follow-ap visit time were 18.2 months.In no numb group,legs and feet were not anesthesia.Difference of two point discrimination in dorsum of foot between two groups had not statistically significant perioperatively.In numb group,the anesthesia symptoms vanished or decreased rate of leg and foot was 92.9%after neurolysis.Two point discrimiriation in dorsum of foot in treatment group was 25.6mm±5.5 mm before neurolysis and 12.2mm±5.8 mm after neurolysis,there was statistically significant between before and after neurolysis,P＜0.05.Foot pain scores(visual analogue scales,VAS) in the control group were not-statistically significant comparing those scores in the treatment group before operation.After operation,that was pain aggravating rate.However,in the numb group,easement of pain rate was 82%,pain invariant rate was 18%,pain aggravating rate was zero.Foot pain scores and the VAS scores decreased proportion difference was statistically significant perioperatively between the two groups.Difference of ankle brachial index(ABI) and both lower extremities CT angiography(CTA) in two groups was not statistically significant perioperatively.Ulcer or wound agglutination time of the control group was 24±7d,and the treatment group was 18±4d,their difference was statistically significant,P＜0.05.Foot ulcer pathological finding of the control group after operation one week revealed that granulation blood capillary proliferated,diffused distribution;however,the treatment group revealed that granulation blood capillary proliferated in large quantity,widely spread reticular distribution.The difference of the results of the pathological finding was statistically significant.Follow-up visit recurrence rate of diabetic foot ulcer of the control group after 3 months was 22.2%,below knee amputation rate was 5.6%;and the treatment group recurrence rate was 7.4%,below knee amputation rate was 3.7%,there was not significant difference between two groups.CONCLUSIONS:Neurolysis of peripheral nerve for the treatment of diabetic foot could relieve anesthesia and nerve pricking pain symptoms,accelerate ulcer agglutination,decrease diabetic foot ulcer recurrence rate and below knee amputation rate.We supposed that relieving dropsy of peripheral nerve of the lower limbs and relieving compression and improving diabetic foot condition of out of neurotrophy may be the mechanism that neurolysis accelerated diabetic foot ulcer or wound agglutination.