Effectiveness of lower extremity Dellon triple nerve decompression in treatment of early-stage diabetic Charcot foot_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

Maiwulajiang·maimaijiang , Maimaiaili·yushan , Alimujiang·abulaiti , REN Peng ,  Aihemaitijiang·yusufu

Department of Microreconstructive Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830011, P.R.China;

Corresponding author：

Aihemaitijiang·yusufu, Email: Ahmatjang@163.com

Keywords：

Diabetes; Charcot foot; Dellon triple nerve entrapment; Dellon triple nerve decompression; osteoporosis

DOI：

10.7507/1002-1892.201912085

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Objective To study the effectivenss of lower extremity Dellon triple nerve decompression in the treatment of early-stage diabetic Charcot foot.Methods The clinical data of 24 patients with Eichenholtz stage 0-1 diabetic Charcot foot who were admitted between September 2017 and February 2019 were retrospectively analyzed. Among them, 14 cases were treated with lower extremity Dellon triple nerve decompression (treatment group), and 10 cases were treated with conservative treatment such as immobilization the affected limbs and nutritional nerve drugs (control group). There was no significant difference between the two groups (P>0.05) in gender, age, diabetes duration, diabetic foot duration, Eichenholtz stage, and the blood glucose level, bone mineral density (T value), nerve conduction velocity, and two-point discrimination before treatment. Before treatment and at 6 months after treatment, bone mineral density (T value) was measured by dual energy X-ray absorptiometry to evaluate the improvement of osteoporosis. The electromyogram of the lower limbs was used to detect the conduction velocity of the common peroneal nerve, deep peroneal nerve, and tibial nerve, and to evaluate the recovery of nerve function. The two-point discrimination in plantar region was used to evaluate the recovery of skin sensation.Results Both groups were followed up 6-12 months, with an average of 6.5 months. In the treatment group, 3 patients showed numbness around the incisions, all recovered after 12 months, without affecting the prognosis; all the incisions healed by first intention, and there was no complication such as incision infection, nonunion, or vascular and nerve injury. At 6 months after treatment, there was no significant difference in nerve conduction velocity, bone mineral density (T value), and two-point discrimination when compared with the values before treatment (P>0.05) in the control group; but the above indicators in the treatment group were significantly improved when compared with preoperative ones, and were all significantly better than those in control group (P<0.05).Conclusion Lower extremity Dellon triple nerve decompression can improve the symptoms of Eichenholtz stage 0-1 diabetes Charcot foot, and has the advantages of less trauma, faster recovery, and fewer complications.

Citation： Maiwulajiang·maimaijiang, Maimaiaili·yushan, Alimujiang·abulaiti, REN Peng, Aihemaitijiang·yusufu. Effectiveness of lower extremity Dellon triple nerve decompression in treatment of early-stage diabetic Charcot foot. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(8): 1005-1011. doi: 10.7507/1002-1892.201912085 Copy

1.	Rogers LC, Frykberg RG, Armstrong DG, et al. The Charcot foot in diabetes. Diabetes Care, 2011, 34(9): 2123-2129.
2.	Jansen RB, Svendsen OL. A review of bone metabolism and developments in medical treatment of the diabetic Charcot foot. J Diabetes Complications, 2018, 32(7): 708-712.
3.	Schade VL, Andersen CA. A literature-based guide to the conservative and surgical management of the acute Charcot foot and ankle. Diabet Foot Ankle, 2015, 6: 26627.
4.	Güven MF, Karabiber A, Kaynak G, et al. Conservative and surgical treatment of the chronic Charcot foot and ankle. Diabet Foot Ankle, 2013, 4. doi: 10.3402/dfa.v4i0.21177. Print 2013.
5.	顾立强. 周围神经学组建设与学术进展. 中国修复重建外科杂志, 2018, 32(7): 786-791.
6.	王志伟, 吴学建, 朱旭, 等. 夏科氏足的病理生理和诊疗新进展. 中国实用医刊, 2018, 45(3): 123-126.
7.	Tu Y, Lineaweaver WC, Chen Z, et al. Surgical decompression in the treatment of diabetic peripheral neuropathy: A systematic review and meta-analysis. J Reconstr Microsurg, 2017, 33(3): 151-157.
8.	Zhong W, Yang M, Zhang W, et al. Improved neural microcirculation and regeneration after peripheral nerve decompression in DPN rats. Neurol Res, 2017, 39(4): 285-291.
9.	梁峰, 胡大一, 沈珠军. 2014美国糖尿病指南: 糖尿病诊疗标准. 中华临床医师杂志 (电子版), 2014, 8(6): 151-159.
10.	Rosenbaum AJ, DiPreta JA. Classifications in brief: Eichenholtz classification of Charcot arthropathy. Clin Orthop Relat Res, 2015, 473(3): 1168-1171.
11.	Markéta Štveráková, Michaela Steklá, Miroslav Selčan, et al. Evaluation of benefit of low dose CT in the diagnosis of Charcot arthropathy. World Congress on Medical Physics and Biomedical Engineering, 2019.
12.	王芳, 王婧, 王宇, 等. 杵针对糖尿病高危足患者足部感觉神经功能和症状的影响. 上海针灸杂志, 2019, 38(6): 623-629.
13.	樊宇超, 刘慧, 杨邦祥. 机制导向性神经病理性疼痛治疗新进展. 华西医学, 2015, 30(5): 971-975.
14.	Cardoso CR, Moran CB, Marinho FS, et al. Increased aortic stiffness predicts future development and progression of peripheral neuropathy in patients with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study. Diabetologia, 2015, 58(9): 2161-2168.
15.	赵斌, 马剑雄, 马信龙. 组织工程周围神经血管化研究进展. 中国修复重建外科杂志, 2019, 33(8): 1029-1032.
16.	Fauzi AA, Chung TY, Latif LA. Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre. Singapore Med J, 2016, 57(4): 198-203.
17.	Gouveri E, Papanas N. Charcot osteoarthropathy in diabetes: A brief review with an emphasis on clinical practice. World J Diabetes, 2011, 2(5): 59-65.
18.	Hastings MK, Johnson JE, Strube MJ, et al. Progression of foot deformity in Charcot neuropathic osteoarthropathy. J Bone Joint Surg (Am), 2013, 95(13): 1206-1213.
19.	王志强, 吕泽斌. 糖尿病 Charcot 足诊治现状及早期误诊分析. 全科口腔医学杂志 (电子版), 2019, 6(19): 152-153.
20.	Beuscher TL. Guidelines for diabetic foot care: A template for the care of all feet. J Wound Ostomy Continence Nurs, 2019, 46(3): 241-245.
21.	Sirous Azizi, Sharif Najafi, Zahra Rezasoltani, et al. Effects of aerobic exercise on electrophysiological features of diabetic peripheral neuropathy: single-blind clinical trial. Topics in Geriatric Rehabilitation, 2019, 35(2): 164-169.
22.	魏剑芬, 王颖, 吴乃君, 等. 糖尿病周围神经病变患者血清神经元特异性烯醇化酶与神经传导速度的关系. 中国糖尿病杂志, 2016, 24(6): 528-531.
23.	Ghosh D, Peng J, Brown K, et al. Super-resolution ultrasound imaging of skeletal muscle microvascular dysfunction in an animal model of type 2 diabetes. J Ultrasound Med, 2019, 38(10): 2589-2599.
24.	Norbury JW, Boyer PJ. Response to ‘A technical note for ultrasound imaging of the peripheral nerve mass lesions’. Am J Phys Med Rehabil, 2019, 98(6): e62-e63.
25.	Vujosevic S, Muraca A, Alkabes M, et al. Early microvascular and neural changes in patients with type 1 and type 2 diabetes mellitus without clinical signs of diabetic retinopathy. Retina, 2019, 39(3): 435-445.
26.	Dellon AL, Mackinnon SE. Tibial nerve branching in the tarsal tunnel. Arch Neurol, 1984, 41(6): 645-646.
27.	Dellon AL. The Dellon approach to neurolysis in the neuropathy patient with chronic nerve compression. Handchir Mikrochir Plast Chir, 2008, 40(6): 351-360.
28.	Jansen RB, Christensen TM, Bülow J, et al. Bone mineral density and markers of bone turnover and inflammation in diabetes patients with or without a Charcot foot: An 8.5-year prospective case-control study. J Diabetes Complications, 2018, 32(2): 164-170.
29.	Suyama H, Moriwaki K, Niida S, et al. Osteoporosis following chronic constriction injury of sciatic nerve in rats. J Bone Miner Metab, 2002, 20(2): 91-97.

1. Rogers LC, Frykberg RG, Armstrong DG, et al. The Charcot foot in diabetes. Diabetes Care, 2011, 34(9): 2123-2129.
2. Jansen RB, Svendsen OL. A review of bone metabolism and developments in medical treatment of the diabetic Charcot foot. J Diabetes Complications, 2018, 32(7): 708-712.
3. Schade VL, Andersen CA. A literature-based guide to the conservative and surgical management of the acute Charcot foot and ankle. Diabet Foot Ankle, 2015, 6: 26627.
4. Güven MF, Karabiber A, Kaynak G, et al. Conservative and surgical treatment of the chronic Charcot foot and ankle. Diabet Foot Ankle, 2013, 4. doi: 10.3402/dfa.v4i0.21177. Print 2013.
5. 顾立强. 周围神经学组建设与学术进展. 中国修复重建外科杂志, 2018, 32(7): 786-791.
6. 王志伟, 吴学建, 朱旭, 等. 夏科氏足的病理生理和诊疗新进展. 中国实用医刊, 2018, 45(3): 123-126.
7. Tu Y, Lineaweaver WC, Chen Z, et al. Surgical decompression in the treatment of diabetic peripheral neuropathy: A systematic review and meta-analysis. J Reconstr Microsurg, 2017, 33(3): 151-157.
8. Zhong W, Yang M, Zhang W, et al. Improved neural microcirculation and regeneration after peripheral nerve decompression in DPN rats. Neurol Res, 2017, 39(4): 285-291.
9. 梁峰, 胡大一, 沈珠军. 2014美国糖尿病指南: 糖尿病诊疗标准. 中华临床医师杂志 (电子版), 2014, 8(6): 151-159.
10. Rosenbaum AJ, DiPreta JA. Classifications in brief: Eichenholtz classification of Charcot arthropathy. Clin Orthop Relat Res, 2015, 473(3): 1168-1171.
11. Markéta Štveráková, Michaela Steklá, Miroslav Selčan, et al. Evaluation of benefit of low dose CT in the diagnosis of Charcot arthropathy. World Congress on Medical Physics and Biomedical Engineering, 2019.
12. 王芳, 王婧, 王宇, 等. 杵针对糖尿病高危足患者足部感觉神经功能和症状的影响. 上海针灸杂志, 2019, 38(6): 623-629.
13. 樊宇超, 刘慧, 杨邦祥. 机制导向性神经病理性疼痛治疗新进展. 华西医学, 2015, 30(5): 971-975.
14. Cardoso CR, Moran CB, Marinho FS, et al. Increased aortic stiffness predicts future development and progression of peripheral neuropathy in patients with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study. Diabetologia, 2015, 58(9): 2161-2168.
15. 赵斌, 马剑雄, 马信龙. 组织工程周围神经血管化研究进展. 中国修复重建外科杂志, 2019, 33(8): 1029-1032.
16. Fauzi AA, Chung TY, Latif LA. Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre. Singapore Med J, 2016, 57(4): 198-203.
17. Gouveri E, Papanas N. Charcot osteoarthropathy in diabetes: A brief review with an emphasis on clinical practice. World J Diabetes, 2011, 2(5): 59-65.
18. Hastings MK, Johnson JE, Strube MJ, et al. Progression of foot deformity in Charcot neuropathic osteoarthropathy. J Bone Joint Surg (Am), 2013, 95(13): 1206-1213.
19. 王志强, 吕泽斌. 糖尿病 Charcot 足诊治现状及早期误诊分析. 全科口腔医学杂志 (电子版), 2019, 6(19): 152-153.
20. Beuscher TL. Guidelines for diabetic foot care: A template for the care of all feet. J Wound Ostomy Continence Nurs, 2019, 46(3): 241-245.
21. Sirous Azizi, Sharif Najafi, Zahra Rezasoltani, et al. Effects of aerobic exercise on electrophysiological features of diabetic peripheral neuropathy: single-blind clinical trial. Topics in Geriatric Rehabilitation, 2019, 35(2): 164-169.
22. 魏剑芬, 王颖, 吴乃君, 等. 糖尿病周围神经病变患者血清神经元特异性烯醇化酶与神经传导速度的关系. 中国糖尿病杂志, 2016, 24(6): 528-531.
23. Ghosh D, Peng J, Brown K, et al. Super-resolution ultrasound imaging of skeletal muscle microvascular dysfunction in an animal model of type 2 diabetes. J Ultrasound Med, 2019, 38(10): 2589-2599.
24. Norbury JW, Boyer PJ. Response to ‘A technical note for ultrasound imaging of the peripheral nerve mass lesions’. Am J Phys Med Rehabil, 2019, 98(6): e62-e63.
25. Vujosevic S, Muraca A, Alkabes M, et al. Early microvascular and neural changes in patients with type 1 and type 2 diabetes mellitus without clinical signs of diabetic retinopathy. Retina, 2019, 39(3): 435-445.
26. Dellon AL, Mackinnon SE. Tibial nerve branching in the tarsal tunnel. Arch Neurol, 1984, 41(6): 645-646.
27. Dellon AL. The Dellon approach to neurolysis in the neuropathy patient with chronic nerve compression. Handchir Mikrochir Plast Chir, 2008, 40(6): 351-360.
28. Jansen RB, Christensen TM, Bülow J, et al. Bone mineral density and markers of bone turnover and inflammation in diabetes patients with or without a Charcot foot: An 8.5-year prospective case-control study. J Diabetes Complications, 2018, 32(2): 164-170.
29. Suyama H, Moriwaki K, Niida S, et al. Osteoporosis following chronic constriction injury of sciatic nerve in rats. J Bone Miner Metab, 2002, 20(2): 91-97.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of lower extremity Dellon triple nerve decompression in treatment of early-stage diabetic Charcot foot

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