Late follow-up of peripheral neural decompression in leprosy: functional and clinical outcomes

ABSTRACT Background: Peripheral neural surgical decompression (PNSD) is used as a complementary therapy to the clinical treatment of neuritis to preserve neural function. Objective: To evaluate the long-term (≥ 1 year) clinical and functional results for PNSD in leprosy neuritis. Methods: This cross-sectional study included leprosy patients who were in late postoperative period (LPO) of surgical decompression of ulnar, median, tibial, and fibular nerves. Socioeconomic, epidemiological, and clinical data were collected. The following instruments were used in this evaluation: visual analogue pain scale (VAS), Douleur Neuropathique en 4 Questions (DN4), SALSA scale, and simplified neurological assessment protocol. The preoperative (PrO) and 180-day postoperative (PO180) results were compared. Results: We evaluated 246 nerves from 90 patients: 56.6% were on multidrug therapy (MDT) and 43.3% discharged from MDT. Motor scores and pain intensity showed statistically significant improvement (p<0.01). There was an increase in sensory scores only for bilateral ulnar nerves (p<0.05). Of the operated cases, 26.0% of patients were referred for surgery of ulnar neuritis and 23.6% of tibial neuritis. Neuropathic pain was reported in 41% of cases. Daily dose of prednisone reduced from 39.6 mg (±3.0) in PrO, 16.3 mg (±5.2) in PO180, to 1.7 mg (±0.8) in LPO. The SALSA scale results showed mild activity limitation in 51% and moderate in 34% of patients. Eighty percent of individuals reported that the results reached their expectations. Conclusions: PNSD in leprosy was effective in the long term to decrease the prevalence and intensity of pain, improve motor function, and reduce the dose of corticosteroids, which is reflected in the patients’ satisfaction.

摘要
背景：外周神经手术减压术（Peripheral neural surgical decompression，PNSD）作为神经炎临床治疗的辅助手段，用于保留神经功能。
目的：评估外周神经手术减压术（PNSD）治疗麻风神经炎的长期（≥1年）临床与功能结局。
方法：本项横断面研究纳入了接受尺神经、正中神经、胫神经及腓神经手术减压，且处于术后晚期（LPO）的麻风患者。收集患者的社会经济学、流行病学及临床资料。本次评估采用以下工具：视觉模拟疼痛量表（Visual Analogue Pain Scale，VAS）、Douleur Neuropathique en 4 Questions（DN4）量表、SALSA量表以及简化神经功能评估方案。比较术前（PrO）与术后180天（PO180）的评估结果。
结果：本研究共评估90例患者的246条神经：其中56.6%的患者接受多药联合治疗（multidrug therapy，MDT），43.3%的患者已停止MDT治疗。运动评分与疼痛强度均出现具有统计学意义的改善（p<0.01）。仅双侧尺神经的感觉评分出现显著升高（p<0.05）。在手术病例中，26.0%的患者因尺神经炎接受手术，23.6%因胫神经炎接受手术。41%的病例报告存在神经性疼痛。泼尼松每日剂量从术前（PrO）的39.6mg（±3.0）降至术后180天（PO180）的16.3mg（±5.2），最终降至术后晚期（LPO）的1.7mg（±0.8）。SALSA量表结果显示，51%的患者存在轻度活动受限，34%存在中度活动受限。80%的受试者表示手术结局符合其预期。
结论：外周神经手术减压术（PNSD）治疗麻风神经炎的长期效果确切，可降低疼痛的患病率与强度、改善运动功能并减少糖皮质激素的使用剂量，这一获益也体现在患者的较高满意度中。