Clinical Study Of Dialysis-related Peripheral Neuropathy

ObjectiveTo study the effectiveness of microsurgical decompression of peripheral nerves for treatment of dialysis-related peripheral neuropathy(DRPN)of upper limbs.MethodsThe clinical data of 15 DRPN patients with upper extremity admitted to neurosurgery of China-Japan friendship hospital from January 2017 to December 2017 were analyzed retrospectively.There were 22 upper limbs of 15 patients with symptoms,among which 2 were treated with median nerve decompression alone and 20 with median nerve and ulnar nerve decompression.After discharge,all patients were followed up in outpatient department,including reexamination of electromyogram,and inquiry of improvement of numbness and pain symptoms to evaluate the effect of operations.ResultsThe operation was successful in all the 15 cases.Six incisions of patients had poor healing,which improved after conservative treatment.The follow-up time was(12±4.50)months(6-20months).The results of reexamination showed that the conduction velocity of median nerve sensory conduction[(46.3±3.1)m/s]and the amplitude of action potential[(9.2±1.6)mV]increased[(37.5±1.8)m/s,(7.7±1.1)mV,respectively,P<0.05]compared with that before operation.The motor conduction velocity[(47.7±2.8)m/s]and the amplitude of action potential[(10.1 ± 1.9)mV]were also increased[(37.8±2.4)m/s,(7.7±1.6)mV,P<0.05].The sensory conduction velocity of ulnar nerve[(45.0±3.6)m/S]and action potential amplitude[(9.2±2.1)mV]increased compared with that before operation[(36.4±2.9)m/s,(6.9±1.2)mV,P<0.05].The motor conduction of ulnar nerve[(45.8±3.2)m/s]and action potential amplitude[(8.6±2.5)mV]increased[(40.1±1.6)m/s and(6.2±1.3)mV,P<0.05].At last,pain symptoms were relieved in 22 sides(22/22),numbness in 16 sides(16/22)and motor dysfunction in 20 sides(20/22)ConclusionsIt is suggested that micro-decompression of peripheral nerves is an effective method for the treatment of DRPN in the upper extremity,and the key to ensure the curative effect is to make sure the diagnosis and complete decompression during the operationObjective:To investigate the effect of microsurgical decompression for median nerve compression syndrome caused by different etiology.Methods:The clinical data of 68 sides of patients with median nerve compression syndrome were analyzed retrospectively.All patients were treated with median nerve micro decompression.BCTQ symptom and function score and median nerve conduction velocity were used to compare the three groups.Results:1.The range of neuropathy in diabetic group was wider than that in idiopathic group and dialysis group.2.Two BCTQ symptom and functional scores were significantly improved in the three groups after operation(P<0.05),and there was no significant difference between the three groups in the degree of improvement after operation(P>0.05);3.Sensory nerve conduction velocity and motor nerve conduction velocity were significantly improved in the three groups after operation,and the difference was statistically significant(P<0.05))There was significant difference between the three groups(P<0.05)in the degree of improvement after operation and before operation.Compared with the two groups,the degree of improvement in the dialysis group and the idiopathic group was significantly better than that in the diabetes group(P<0.05).There was no significant difference between the dialysis group and the idiopathic group(P>0.05).4.Pathological examination showed that the elastic fibers of the transverse carpal ligament decreased in the diabetic group and amyloidosis of the transverse carpal ligament in the dialysis group.5.The quantitative analysis of ?2-microglobulin in the three groups showed that the dialysis group increased significantly(P<0.05);the difference between the two groups was statistically significant(P<0.05).6.Complications:the incidence of incision malunion was 5%(1/20)in the idiopathic group,15.3%(4/26)in the diabetic group and 18.1%(4/22)in the dialysis group.There was a significant difference between the three groups(P<0.05).There was no significant difference in incision complications between the two groups(P<0.05).Conclusion:The pathogenesis of DM related median nerve compression syndrome may be related to the decrease of the elasticity of the transverse carpal ligament.The pathogenesis of dialysis associated median nerve compression syndrome may be related to amyloidosis of the transverse carpal ligament.Microsurgical decompression can achieve satisfactory results in the treatment of dialysis related median nerve compression syndrome,diabetes related median nerve compression syndrome and idiopathic median nerve compression syndrome.The surgical effect of idiopathic and dialysis related median nerve compression syndrome is better than that of diabetes related median nerve compression syndrome,which may be related to the wider range of neuropathy in the latter,so the surgical decompression range should be larger.Incision complications are more common in patients with diabetes related median nerve compression syndrome and dialysis related median nerve compression syndrome.ObjectiveTo compare the efficacy of subcutaneous transection of ulnar nerve and submuscular transection in the treatment of dialysis-related ulnar nerve entrapment syndrome.Methods37 patients with dialysis-related ulnar nerve entrapment syndrome,including 23 bilateral patients,14 unilateral patients,a total of 60 ulnar nerves.It was randomly divided into subcutaneous preposition group(30 sides)and "Z" shape submuscular preposition group(30 sides)with random number table method.The operative effects,operative time,braking time and operative complications were compared.ResultsAccording to the evaluation criteria of ulnar nerve function after repairing,the excellent and good rate of subcutaneous previa group was superior to submuscular previa group,but the difference was not statistically significant(P>0.05).The operation time and braking time of subcutaneous previa group were better than that of submuscular previa group,and the difference was statistically significant(P<0.05).Subcutaneous previa group had less poor wound healing than submuscular previa group,and the difference was not statistically significant(P>0.05).Subcutaneous hematoma formation was less than that of submuscular preconditioning group,and the difference was statistically significant(P<0.05).ConclusionsFor patients with dialysis-related ulnar nerve compression syndrome,both subcutaneous previa and submuscular previa can achieve satisfactory efficacy.And the operation of subcutaneous preposition is simple,less traumatic,shorter operation time,which is more suitable for patients with dialysis-related ulnar nerve entrapment syndrome.