The Ultrasonography Characteristics Research Of Lower Limb Nerve And Foot Back Muscle In Diabetic Peripheral Neuropathy Patients

Objective:To study the ultrasonographic characteristics of the common peroneal nerve,sural nerve,tibial nerve and extensor digitorum brevis in diabetic peripheral neuropathy by high-frequency ultrasound,and to discuss the clinical value of high-frequency ultrasound in peripheral nerve and musculoskeletal system.Materials and methods:1.During May 2017 to September 2018,according to whether diabetic peripheral neuropathy was associated with diabetes mellitus,53 patients in DPN group and 49 patients in non-DPN group were divided into two groups.At the same time,52 healthy volunteers were collected as control group..2.We scanned the common peroneal nerve,sural nerve and tibial nerve of the tower extremity by high-frequency ultrasound,observed the shape,contour,internal echo of each nerve and their adjacent relationshp with the surrounding tissues.We measured and recorded the left and right diameters(D1)and the anterior and posterior diameters(D2),and calculated the cross-sectional area(CSA)by the formula CSA=D1*D2*π/4.By the way,we observed the internal echo of the extensor digitorum brevis,and measured the maximum thickness and cross sectional area.3.We divided the patients in group DPN into three groups according to the courses of disease:5-10 years,11-15 years and>15 years,compared the ultrasonic images of lower extremity nerves and dorsum muscles of foots ofpatients with different courses of disease,and observed the differences among D1,D2 and CSA.4.We applicated SPSS 21.0 software for data statistical analysis,the difference was statistically significant when P<0.05.Result:1.In the normal control group,the nerves showed elliptical ethmoid hyperechoic in transverse section,linear hyperechoic in longitudinal section,clear shape,and clear demarcation between epineurium and surrounding tissues.2.The proportion of gray-scale ultrasonographic changes in lower limb nerves such as uneven internal echo reduction,unclear demarcation between epineurium and surrounding tissues,blurred or disappeared sieve network structure in DPN group was the highest,and the increase of D1,D2 and CSA was the most obvious,followed by non-DPN group.There was significant difference between the two groups and the control group.3.Sural nerve was more prone to abnormal ultrasonographic changes than common peroneal nerve and tibial nerve in DPN patients.4.In DPN patients with different courses of disease,D1,D2 and CSA of lower extremity nerve in the group of>15 years were significantly higher than those in the group of 5-10 years,and CSA of extensor digitorum brevis muscle in the group of>15 years was significantly lower than that in the group of 5-10 years,the differences were statistically significant(P<0.05).Conclusion:1.High frequency ultrasound can clearly reflect the morphological changes of lower extremity nerves in diabetic peripheral neuropathy,and provide certain imaging basis for the diagnosis and follow-up of DPN.2.The changes of sural nerve gary scale ultrasonic image were earlier than that of the common peroneal nerve and tibial nerve.3.High-frequency ultrasound can clearly show the ultrasonographic changes of extensor digitorum brevis muscle.By measuring the thickness and cross-sectional area of muscle,it can reflect the atrophy of dorsalis pedis muscles in diabetic patients and DPN patients,so as to achieve early intervention and prevention.