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中华神经创伤外科电子杂志 ›› 2025, Vol. 11 ›› Issue (05) : 298 -306. doi: 10.3877/cma.j.issn.2095-9141.2025.05.004

临床研究

周围神经松解术治疗中-重型尿毒症周围神经病变的疗效评估
戴伟川, 郭协力†(), 蔡文华, 孙敏, 陈英贤, 齐震   
  1. 362200　福建晋江，晋江市医院（上海市第六人民医院福建医院）神经外科
  • 收稿日期:2024-11-04 出版日期:2025-10-15
  • 通信作者: 郭协力

Evaluation of the efficacy of peripheral neurolysis in the treatment of moderate-severe uremic peripheral neuropathy

Weichuan Dai, Xieli Guo†(), Wenhua Cai, Min Sun, Yingxian Chen, Zhen Qi   

  1. Department of Neurosurgery, Jinjiang Municipal Hospital (Shanghai Sixth People's Hospital, Fujian Campus), Jinjiang 362200, China
  • Received:2024-11-04 Published:2025-10-15
  • Corresponding author: Xieli Guo
  • Supported by:
    Fujian Provincial Health Commission Science and Technology Program(2022CXA059); Quanzhou Science and Technology Plan Project(2023NS098, 2025QZNY125); Fujian Science and Technology Innovation Joint Fund Project(2025Y9536)
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引用本文：

戴伟川, 郭协力, 蔡文华, 孙敏, 陈英贤, 齐震. 周围神经松解术治疗中-重型尿毒症周围神经病变的疗效评估[J/OL]. 中华神经创伤外科电子杂志, 2025, 11(05): 298-306.

Weichuan Dai, Xieli Guo, Wenhua Cai, Min Sun, Yingxian Chen, Zhen Qi. Evaluation of the efficacy of peripheral neurolysis in the treatment of moderate-severe uremic peripheral neuropathy[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2025, 11(05): 298-306.

目的

评估周围神经松解术治疗中-重型尿毒症周围神经病（UPN）的临床疗效，并初步探讨其作用机制。

方法

选取晋江市医院神经外科和血透室自2022年1月至2024年8月收治的中-重型UPN患者53例，采用随机数字表法分为治疗组（27例）和对照组（26例）。治疗组行周围神经松解术，对照组采取保守治疗。采用视觉模拟评分法（VAS）、多伦多临床神经病变评分法（TCSS）、定量感觉功能测定（QST）、神经运动神经传导速度（MNCV）和感觉神经传导速度（SNCV）评估2组患者的临床疗效；肌骨超声测量2组患者治疗前后的神经直径粗细变化情况。比较2组患者治疗前后血清C反应蛋白（CRP）、肿瘤坏死因子-a（TNF-a）、白细胞介素（IL）-6及IL-8的浓度。

结果

治疗组脱落4例，最终纳入23例，对照组脱落2例，最终纳入24例。2组患者的性别、年龄、平均病程、透析平均时间、原发病等比较，差异无统计学意义（P>0.05）。治疗组治疗后的VAS和TCSS评分、VPT、WPT均低于对照组，且低于同组治疗前；治疗组治疗后的CPT及MNCV、SNCV评分均高于对照组，且高于同组治疗前，差异均有统计学意义（P<0.05）。治疗组治疗后的肌骨超声神经直径小于对照组，且小于同组治疗前，差异均有统计学意义（P<0.05）。2组患者治疗后血清CRP、TNF-a、IL-6、IL-8较治疗前均显著降低，且治疗组低于对照组，差异均有统计学意义（P<0.05）。

结论

周围神经松解术治疗中-重型UPN临床疗效显著，可有效缓解疼痛等症状，使肿胀卡压神经回缩，神经传导速度增快，减轻炎症反应。手术安全性高，不良反应少。

关键词: 尿毒症周围神经病, 周围神经松解术, 临床疗效, 炎症因子
Objective

To evaluate the efficacy of peripheral nerve decompression surgery in the treatment of moderate-severe uremic peripheral neuropathy (UPN) and to explore the possible mechanisms of action.

Methods

Fifty-three patients with moderate-severe UPN treated at Neurosurgery Department and Hemodialysis Center of Jinjiang Hospital from January 2022 to August 2024 were selected and randomly divided into a treatment group (27 cases) and a control group (26 cases) using a random number table method. The control group received conservative treatment, while the treatment group underwent peripheral nerve decompression surgery. The clinical effects of the two groups were evaluated using visual analog scale (VAS), Toronto clinical scoring system (TCSS), quantitative sensory testing (QST), nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV). Musculoskeletal ultrasound was used to measure the changes in nerve diameter and thickness in both groups before and after treatment. The concentrations of C reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) in the two groups were compared before and after treatment.

Results

In the treatment group, 23 cases were included and 4 cases were shed, and in the control group, 24 cases were included and 2 cases were shed. There was no statistically significant difference in gender, age, average disease duration, average dialysis time, and primary disease between the two groups (P>0.05). The VAS and TCSS scores, VPT, and WPT of the treatment group were lower than those of the control group after treatment, and lower than those before treatment in the same group; the CPT, MNCV, and SNCV scores in the treatment group were higher than those in the control group after treatment, and were also higher than those before treatment in the same group, with statistically significant differences (P<0.05). The diameter of the muscle bone ultrasound nerve in the treatment group after treatment was smaller than that in the control group, and also smaller than that before treatment in the same group, with statistical significance (P<0.05). After treatment, the serum levels of CRP, TNF, IL-6, and IL-8 in both groups of patients were significantly reduced compared to before treatment, and the treatment group was lower than the control group, with statistically significant differences (P<0.05).

Conclusions

Peripheral neurolysis has significant clinical effects in the treatment of moderate-severe UPN. This surgical approach can effectively alleviate symptoms such as pain, cause swelling and compression of nerves, increase nerve conduction velocity, and reduce inflammatory reactions. The surgical safety is high and there are few adverse reactions.

Key words: Uremic peripheral neuropathy, Peripheral nerve lysis, Clinical effect, Inflammatory factor
图1 上下肢周围神经卡压部位示意图A：上肢正中、尺神经卡压部位（箭头所示）；B：下肢胫后、腓总、腓浅、腓深神经卡压部位（箭头所示）
Fig.1 Schematic diagram of peripheral nerve compression sites in the upper and lower limbs
表1 2组中-重型UPN患者一般资料比较
Tab.1 Comparison of general information between two groups of moderate-severe UPN patients
因素 治疗组（n=23） 对照组（n=24） χ2/t值 P值
性别     0.016 0.900
男 13 14    
女 10 10    
年龄（岁，±s） 52.82±7.33 51.94±8.24 0.386 0.701
原发病     0.052 0.837
原发性肾小球肾炎 9 9    
慢性肾盂肾炎 5 5    
高血压肾病 2 3    
多囊肾 5 4    
梗阻性肾病 2 3    
透析时间（年，±s） 5.71±1.60 5.81±1.19 0.244 0.809
病程（年，±s） 3.72±0.49 3.68±0.91 0.186 0.853
表2 2组中-重型UPN患者治疗前后VAS、TCSS评分比较（分，±s）
Tab.2 Comparison of VAS and TCSS scores before and after treatment in two groups of moderate to severe UPN patients (score, Mean±SD)
项目   对照组（n=24） 治疗组（n=23） t值 P值
VAS评分 治疗前 7.76±1.75 7.94±1.78 0.350 0.727
治疗后 7.49±1.15 1.24±1.23 17.975 <0.001
t值 0.849 22.35    
P值 0.404 <0.001    
TCSS评分 治疗前 17.93±1.34 17.03±1.74 1.978 0.054
治疗后 17.57±1.97 8.24±1.23 19.642 <0.001
t值 1.014 31.72    
P值 0.321 <0.001    
表3 2组中-重型UPN患者治疗前后QST结果比较（±s）
Tab.3 Comparison of QST results before and after treatment in two groups of moderate to severe UPN patients (Mean±SD)
项目   对照组（n=24） 治疗组（n=23） t值 P值
VPT（μm） 治疗前 10.53±3.34 12.03±2.74 1.680 0.100
治疗后 9.69±2.16 5.27±1.23 8.570 <0.001
t值 1.035 10.99    
P值 0.306 <0.001    
CPT（℃） 治疗前 22.98±2.79 22.43±2.25 0.742 0.462
治疗后 23.49±1.94 27.78±1.65 8.150 <0.001
t值 0.735 9.196    
P值 0.466 <0.001    
WPT（℃） 治疗前 47.90±1.87 48.68±1.69 1.345 0.186
治疗后 46.97±2.75 35.76±2.98 8.625 <0.001
t值 1.488 18.087    
P值 0.144 <0.001    
表4 2组中-重型UPN患者治疗前后MNCV比较（m/s，±s）
Tab.4 Comparison of MNCV before and after treatment in two groups of moderate to severe UPN patients (m/s, Mean±SD)
项目   对照组（n=24） 治疗组（n=23） t值 P值
正中神经 治疗前 43.1±3.5 42.8±3.7 0.286 0.777
治疗后 44.6±2.5 49.3±2.3 15.583 <0.001
t值 1.905 8.944    
P值 0.069 <0.001    
尺神经 治疗前 41.6±4.2 41.2±4.5 0.308 0.760
治疗后 42.8±3.7 46.9±3.9 3.699 <0.001
t值 1.332 6.110    
P值 0.194 <0.001    
腓总神经 治疗前 39.1±4.4 38.6±4.2 0.398 0.692
治疗后 40.9±3.6 43.8±3.7 2.723 0.009
t值 1.852 5.628    
P值 0.076 <0.001    
胫后神经 治疗前 37.1±3.2 36.9±3.7 0.199 0.844
治疗后 38.7±3.8 41.8±3.1 3.057 0.004
t值 1.723 5.891    
P值 0.098 <0.001    
表5 2组中-重型UPN患者治疗前后SNCV比较（m/s，±s）
Tab.5 Comparison of SNCV before and after treatment in two groups of moderate to severe UPN patients (m/s, Mean±SD)
项目   对照组（n=24） 治疗组（n=23） t值 P值
正中神经 治疗前 52.10±3.41 51.98±3.29 0.123 0.903
治疗后 53.19±2.91 56.31±2.72 3.793 <0.001
t值 -1.957 -7.301    
P值 0.063 <0.001    
尺神经 治疗前 41.40±4.19 40.89±4.51 0.402 0.690
治疗后 42.91±3.12 45.77±3.79 2.830 0.001
t值 -2.218 -6.125    
P值 0.037 <0.001    
腓总神经 治疗前 44.10±4.11 43.67±4.80 0.330 0.743
治疗后 45.91±3.90 49.10±3.19 3.062 0.004
t值 -2.480 -6.300    
P值 0.021 <0.001    
胫后神经 治疗前 35.11±3.71 34.98±3.35 0.126 0.900
治疗后 36.72±3.13 39.89±3.78 3.137 0.003
t值 -2.620 -7.120    
P值 0.015 <0.001    
表6 2组中-重型UPN患者治疗前后肌骨超声神经直径比较（mm，±s）
Tab.6 Comparison of musculoskeletal ultrasound nerve diameters between two groups of moderate-severe UPN patients before and after treatment (mm, Mean±SD)
项目   对照组（n=24） 治疗组（n=23） t值 P值
正中神经 治疗前 3.69±0.24 3.71±0.21 0.304 0.763
治疗后 3.64±0.20 3.01±0.11 13.298 <0.001
t值 0.873 14.783    
P值 0.392 <0.001    
尺神经腕部 治疗前 3.27±0.12 3.23±0.15 1.012 0.317
治疗后 3.21±0.14 2.98±0.13 8.150 <0.001
t值 1.852 8.064    
P值 0.077 <0.001    
尺神经肘部 治疗前 4.19±0.21 4.23±0.15 0.749 0.458
治疗后 4.21±0.14 3.89±0.17 7.057 <0.001
t值 0.408 7.812    
P值 0.686 <0.001    
胫后神经 治疗前 3.36±0.11 3.37±0.15 0.261 0.795
治疗后 3.31±0.14 2.88±0.14 10.526 <0.001
t值 1.581 13.125    
P值 0.127 <0.001    
腓浅神经 治疗前 2.41±0.21 2.37±0.19 0.684 0.498
治疗后 2.38±0.17 1.97±0.21 7.372 <0.001
t值 0.638 8.367    
P值 0.528 <0.001    
腓深神经 治疗前 2.62±0.18 2.57±0.21 0.878 0.395
治疗后 2.59±0.21 2.07±0.12 10.362 <0.001
t值 0.566 11.628    
P值 0.576 <0.001    
腓总神经 治疗前 4.37±0.23 4.33±0.15 0.703 0.486
治疗后 4.30±0.25 3.87±0.12 8.625 <0.001
t值 1.211 16.800    
P值 0.237 <0.001    
表7 治疗组23例中-重型UPN患者治疗前后肾功能比较（±s）
Tab.7 Comparison of preoperative and postoperative renal function in the treatment group of 23 moderate-severe UPN patients (Mean±SD)
肾功能指标 治疗前 治疗后 t值 P值
血清肌酐（mg/dL） 8.51±1.29 8.39±1.13 0.340 0.736
血尿素氮（mg/dL） 65.28±10.31 63.81±9.89 0.499 0.620
eGFR[mL/（min·1.73 m2）] 8.28±2.13 8.56±2.32 0.431 0.669
血钾（mmol/L） 5.21±0.63 5.19±0.57 0.114 0.910
血钠（mmol/L） 135.45±4.51 136.65±4.22 0.942 0.351
血钙（mg/dL） 8.01±0.82 8.12±0.74 0.483 0.631
血磷（mg/dL） 5.82±1.09 5.78±1.12 0.124 0.902
尿蛋白（mg/24 h） 1200.12±250.25 1180.87±230.98 0.274 0.785
尿微量白蛋白（mg/L） 150.14±30.12 145.87±28.97 0.495 0.622
表8 2组中-重型UPN患者治疗有效率比较
Tab.8 Comparison of treatment efficacy between two groups of moderate-severe UPN patients
组别 例数 显效 有效 无效 恶化 有效率[例（%）]
对照组 24 0 6 18 0 6（25.0）
治疗组 23 16 5 2 0 21（91.3）
χ2值           21.122
P值           <0.001
表9 2组中-重型UPN患者治疗前后血清炎症因子浓度比较（±s）
Tab.9 Comparison of serum inflammatory factor concentrations between two groups of moderate-severe UPN patients before and after treatment (Mean±SD)
项目   对照组（n=24） 治疗组（n=23） t值 P值
CRP（μg/mL） 治疗前 111.21±3.91 109.98±3.15 1.235 0.229
治疗后 87.18±2.17 50.31±2.92 82.453 <0.001
t值 33.300 82.453    
P值 <0.001 <0.001    
TNF-α（pg/mL） 治疗前 89.49±4.98 90.92±4.41 0.472 0.641
治疗后 72.98±3.81 45.93±3.74 44.328 <0.001
t值 17.900 44.328    
P值 <0.001 <0.001    
IL-6（pg/mL） 治疗前 74.19±4.18 73.68±4.81 1.876 0.074
治疗后 55.93±3.92 39.16±3.15 32.017 <0.001
t值 22.500 32.017    
P值 <0.001 <0.001    
IL-8（pg/mL） 治疗前 135.12±3.74 134.97±3.89 0.731 0.472
治疗后 107.74±3.19 69.85±3.14 77.562 <0.001
t值 38.000 77.562    
P值 <0.001 <0.001    
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