Retrospektive Langzeitergebnisse nach einer Nervendekompression nach Dellon am Unterschenkel bei Polyneuropathie

Zusammenfassung

Hintergrund Im Rahmen einer Polyneuropathie klagen die Patienten oft über Schmerzen, Kribbeln, Taubheitsgefühle und eine vermehrte Sturzneigung. Nach Ausschöpfen der konservativen Therapiemaßnahmen und bei Fortbestehen der Beschwerden kann über eine Nervendekompression an der unteren Extremität bei vielen Patienten eine Verbesserung der Beschwerden erreicht werden. Wir stellen hier unsere Langzeitergebnisse dieser Operationsmethode vor.

Methode In die Studie wurden 33 Patienten mit einer idiopathischen oder diabetischen Polyneuropathie, bei denen eine Nervendekompression nach Dellon in den Jahren 2011–2013 an der unteren Extremität durchgeführt wurde, eingeschlossen. Untersucht wurden bei 29 von 33 Patienten 3 Monate postoperativ das Schmerzniveau (NRS 0–10), Kribbelparästhesien, Taubheitsgefühl, Hoffman-Tinel-Zeichen und Semmes-Weinstein-Monofilament. 88 Monate postoperativ (78–111 Monate) konnten wir 20 von 33 operierten Patienten anhand eines Fragebogens zum Schmerzniveau (NRS 0–10), zur Zufriedenheit mit dem Ergebnis (NRS 0–10) und zu der Frage, ob die Patienten diese Operation weiterempfehlen würden, befragen.

Ergebnisse 1. Signifikante Schmerzreduktion 3 Monate postoperativ NRS 4,5 auf 2,2 (p=0,000). 2. Signifikante Reduktion der Kribbelparästhesien 3 Monate postoperativ von 84,8% auf 24,2% (p=0,000) 3. Signifikante Reduktion des Taubheitsgefühls 3 Monate postoperativ von 97% auf 39% (p=0,000). 4. Signifikante Verbesserung der Oberflächensensibilität 3 Monate postoperativ von 91% ohne Sensibilität auf 28% ohne Sensibilität (P=0,000). 5. Signifikante Verbesserung des positiven Hoffmann-Tinel-Zeichens 3 Monate postoperativ von 76% auf 13% (p=0,000). Nach 88 Monaten zeigte sich weiterhin eine signifikante Schmerzreduktion im Vergleich zu dem präoperativen Wert von NRS 4,5 auf postoperativ 2,7 (p=0,048). Aufgrund der überwiegenden Patientenzufriedenheit mit einem Wert von 3,4 (0–10 NRS) sowie Angabe einer deutlichen Funktionsverbesserung würden 65% der behandelten Patienten das Verfahren weiterempfehlen.

Schlussfolgerung Die Ergebnisse zeigen, dass mit einer Dekompression nach Dellon an der unteren Extremität eine andauernde Schmerzreduktion und Funktionsverbesserung erzielt werden können.

Abstract

Background Patients affected by polyneuropathy often report pain, paraesthesia and numbness and are at risk of having an increased propensity to fall with the corresponding complications. In case of persistent symptoms after all conservative and medical treatment options have been exhausted, a nerve decompression in the lower leg as described by Dellon can lead to an improvement of the discomfort for many patients. This article presents our long-term results with Dellon’s operation.

Methods In this retrospective study, we included 33 patients with diabetic or idiopathic polyneuropathy in whom we performed Dellon’s nerve decompression in the lower leg in the years 2011–2013. In 29 out of the 33 patients, we investigated the level of pain (according to the numeric rating scale NRS 0–10), paraesthesia, numbness, Hoffman-Tinel sign, and Semmes-Weinstein monofilaments three months postoperatively. 88 months postoperatively (range 78–111 months), we were able to contact 20 of the 33 patients with a questionnaire asking about their present pain level (NRS 0–10), satisfaction with the postoperative result (NRS 0–10, 0=most satisfied, 10=not satisfied at all) and whether the patients would recommend the surgical procedure to their friends or family.

Results 1. Significant pain reduction three months postoperatively, NRS 4.5 to 2.2, (p=0.000). 2. Significant reduction of paraesthesia three months postoperatively from 84.8 to 24.2% (p=0.000) 3. Significant reduction of numbness three months postoperatively from 97% to 39% (p=0.000). 4. Significant improvement of sensitivity three months postoperatively from 91% no sensitivity to 28% no sensitivity (p=0.000). 5. Significant improvement of Hoffmann-Tinel sign three months postoperatively from 76% to 13% (p=0.000). 88 months postoperatively, we saw a significant pain reduction from an average preoperative pain level of NRS 4.5 to a postoperative pain level of 2.7 (p=0.048). 88 months postoperatively, 65% of the patients would recommend the surgical procedure to their family and friends, and patient satisfaction was high (NRS 3,4).

Conclusion Our long-term results show that Dellon’s nerve decompression in the lower extremities leads to a marked, lasting pain reduction and a functional improvement.

Schlüsselwörter

Nervendekompression - Unterschenkel - Langzeitergebnisse - Polyneuropathie

Key words

lower limb - polyneuropathy - nerve decompression - long-term results

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