糖尿病と整形外科的神経疾患

Orthopaedic Neurological Diseases in Patient with Diabetes

糖尿病患者における神経障害の有病率は非常に高率であるといわれる。糖尿病性神経障害は主に多発神経障害と単神経障害に大別され，その症候の多くは多発神経障害と認識されがちだが，実際にはそれらをベースとして絞扼性・圧迫性障害が存在する患者が多く整形外科的治療により改善・治癒する例も存在する。本稿では糖尿病患者において発症しうる整形外科的神経疾患の概要と主に糖尿病に特徴的な上肢神経筋骨格障害について述べた。

Abstract

Individuals with diabetes are at a greater risk for microvascular complications, such as retinopathy, neuropathy, and nephropathy, than are individuals without diabetes. Diabetic neuropathies are complex heterogeneous disorders that include both focal neuropathies and diffuse polyneuropathy.

Entrapment neuropathy is an example of a focal neuropathy, while distal symmetric polyneuropathy is the most common type of diffuse polyneuropathy.

Entrapment neuropathies are highly prevalent in the diabetic population, but they develop insidiously and progressively, making it difficult to determine their true prevalence. Entrapment neuropathies are suspected to be a more common complication of diabetes than is polyneuropathy. For example, carpal tunnel syndrome (CTS)―one of the most common entrapment neuropathies encountered in patients with diabetes―results from median nerve compression, and has been shown to occur three times more frequently in a diabetic population than in a normal healthy population. Entrapment neuropathies should be actively screened for in patients showing the signs and symptoms of neuropathy, because such patients may require surgical treatment.