脊髓电刺激治疗糖尿病足神经性疼痛的初步经验:病例系列报道

doi:10.19854/j.cnki.1008-2425.2025.06.0007

摘要/Abstract

摘要： 目的探讨脊髓电刺激(Spinal Cord Stimulation,SCS)治疗糖尿病足(diabetic foot,DF)相关神经性疼痛的疗效,并分析基于患者体位变化的刺激参数调整需求。方法回顾性分析2024年1月至2024年7月期间于我院接受SCS植入术的4例DF患者的临床资料。术前均接受标准化血糖控制、创面处理和疼痛管理。采用视觉模拟评分(VAS)评估疼痛程度,汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评估心理状态,匹兹堡睡眠质量指数(PSQI)评估睡眠质量。记录并分析患者在不同体位(站立、坐位、卧位)下为达到最佳舒适度与疗效所需的刺激参数调整。结果术后随访4~8个月,4例患者的VAS评分均显著降低,HAMD、HAMA及PSQI评分亦明显改善。所有患者均需根据体位变化调整刺激参数:坐位时参数需低于站立位,卧位时则需进一步降低以获得最大舒适度。患者足部溃疡均有不同程度改善,其中2例近乎完全愈合。结论本研究初步证实SCS可有效缓解DF患者的神经性疼痛,并改善其心理状态与睡眠质量。针对不同体位进行个性化的刺激参数调整,是实现SCS最佳疗效的重要环节。SCS可作为常规治疗效果不佳的DF神经性疼痛患者的一种有价值的治疗选择。

关键词: 脊髓电刺激, 糖尿病足, 神经性疼痛, 心理状态, 疼痛管理

Abstract: Objective To investigate the efficacy of spinal cord stimulation(SCS) for neuropathic pain associated with diabetic foot(DF) and to analyze the requirement for adjustments in stimulation parameters based on patient body positions. Methods A retrospective analysis was conducted on the clinical data of four DF patients who underwent SCS implantation at our center between January and July 2024.All patients received standardized glycemic control,wound care,and pain management preoperatively.Pain severity was assessed using the Visual Analogue Scale(VAS).Psychological status was evaluated with the Hamilton Depression Rating Scale(HAMD) and Hamilton Anxiety Rating Scale(HAMA).Sleep quality was assessed via the Pittsburgh Sleep Quality Index(PSQI).Adjustments to stimulation parameters required for optimal comfort and efficacy in different positions(standing,sitting,lying down) were recorded and analyzed. Results During a follow-up period of 4 to 8 months,significant reductions in VAS scores and improvements in HAMD,HAMA,and PSQI scores were observed in all four patients.All patients required parameter adjustments according to postural changes:parameters in the sitting position were lower than those in the standing position,and a further reduction was necessary in the lying position to ensure maximum comfort.Foot ulcerations showed improvement in all cases,with near-complete healing in two. Conclusion This preliminary study suggests that SCS can effectively alleviate neuropathic pain and improve psychological status and sleep quality in DF patients.Personalized parameter adjustments for different body positions are a crucial component for achieving optimal SCS outcomes.SCS may serve as a valuable therapeutic option for DF patients with neuropathic pain refractory to conventional treatments.

Key words: Spinal cord stimulation, Diabetic foot, Neuropathic pain, Psychological status, Pain management

中图分类号:

常博文, 李政, 吴绍妹, 梅加明. 脊髓电刺激治疗糖尿病足神经性疼痛的初步经验:病例系列报道[J]. 立体定向和功能性神经外科杂志, 2025, 38(6): 361-365.

Chang Bowen, Li Zheng, Wu Shaomei, Mei Jiaming. Preliminary Experience with Spinal Cord Stimulation for Neuropathic Pain in Diabetic Foot:A Case Series.[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2025, 38(6): 361-365.

参考文献

[1] Rehman ZU,Khan J,Noordin S.Diabetic Foot ulcers:contemporary assessment and management[J].J Pak Med Assoc,2023,73(7):1480~1487.
[2] Migdalis I,Czupryniak L,Lalic N,et al.The diabetic foot[J].J Diabetes Res,2017,2017:3585617.
[3] Uckay I,Jornayvaz FR,Lebowitz D,et al.An overview on diabetic foot infections,including issues related to associated pain,hyperglycemia and limb ischemia[J].Curr Pharm Des,2018,24(12):1243~1254.
[4] Liu Y,Li XP,Xu HW,et al..Spinal cord stimulation induces Neurotrophin-3 to improve diabetic foot disease[J].Med Mol Morphol,2025,58(1):43~52.
[5] Gao JB,Bao M.Case report of the treatment of diabetic foot disease using spinal cord stimulation[J].Brain Stimul,2019,12(3):792~793.
[6] Xu X,Fu Y,Bao M.Comparison between the efficacy of spinal cord stimulation and of endovascular revascularization in the treatment of diabetic foot ulcers:a retrospective observational study[J].Neuromodulation,2023,26(7):1424~1432.
[7] Chang BW,Wang S,Mei JM.Neuromodulation for postherpetic neuralgia:Preliminary experience in a single center[J].Clin Neurol Neurosurg,2024,244:108438.
[8] Schnapp WD,Delcroix GJ.Improved sensation resulting from spinal cord stimulation for the treatment of painful diabetic neuropathy:The possible role of stochastic resonance[J].Pain Physician,2022,25(9):E1399~E1403.
[9] Zhou PB,Sun HT,Bao M.Comparative analysis of the efficacy of spinal cord stimulation and traditional debridement care in the treatment of ischemic diabetic foot ulcers:a retrospective cohort study[J].Neurosurgery,2024,95(2):313~321.
[10] Navarro-Flores E,Cauli O.Quality of life in individuals with diabetic foot syndrome[J].Endocr Metab Immune Disord DrugTargets,2020,20(9):1365~1372.
[11] Brooks BM,Shih CD,Brooks BM,et al.The Diabetic Foot-Pain-Depression Cycle[J].J Am Podiatr Med Assoc,2023,113(3):22~126.
[12] Jiang FH,Liu XM,Yu HR,et al.The incidence of depression in patients with diabetic foot ulcers:a systematic review and meta-analysis[J].Int J Low Extrem Wounds,2022,21(2):161~173.
[13] Ahmad A,Abujbara M,Jaddou H,et al..Anxiety and depression among adult patients with diabetic foot:prevalence and associated factors[J].J Clin Med Res,2018,10(5):411~418.
[14] Papanas N,Steiropoulos P.Obstructive sleep apnea and diabetic foot:new responsibilities[J].Angiology,2016,67(7):605~606.
[15] Chen LH,Ma WX,Covassin N,et al.Association of sleep-disordered breathing and wound healing in patients with diabetic foot ulcers[J].J Clin Sleep Med,2021,17(5):909~916.
[16] Masugi Y,Obata H,Nakazawa K.Effects of anode position on the responses elicited by transcutaneous spinal cord stimulation[J].Annu Int Conf IEEE Eng Med Biol Soc,2017,2017:111~114.
[17] Wolter T,Kieselbach K.Cervical spinal cord stimulation:an analysis of 23 patients with long-term follow-up[J].Pain Physician,2012,15(3):203~212.
[18] Binder VE,Hofstoetter US,Rienmüller A,et al.Influence of spine curvature on the efficacy of transcutaneous lumbar spinal cord stimulation[J].J Clin Med,2021,10(23):5543.
[19] Zander HJ,Graham RD,Anaya CJ,et al.Anatomical and technical factors affecting the neural response to epidural spinal cord stimulation[J].J Neural Eng,2020,17(3):036019.
[20] Healy AT,Mageswaran P,Lubelski D,et al.Thoracic range of motion,stability,and correlation to imaging-determined degeneration[J].J Neurosurg Spine,2015,23(2):170~177.
[21] Kiefer A,Parnianpour M,Shirazi-Adl A.Stability of the human spine in neutral postures[J].Eur Spine J,1997,6(1):45~53.
[22] Gibson-Corley KN,Flouty O,Oya H,et al.Postsurgical pathologies associated with intradural electrical stimulation in the central nervous system:design implications for a new clinical device[J].Biomed Res Int.2014,2014:989175.
[23] London D,Mogilner A.Spinal cord stimulation:New Waveforms and Technology[J].Neurosurg Clin N Am,2022,33(3):287~295.
[24] Sun LT,Peng CG,Joosten E,et al.Spinal cord stimulation and treatment of peripheral or central neuropathic pain:mechanisms and clinical application[J].Neural Plast,2021,2021:5607898.
[25] Malinowski MN,Jain S,Jassal N,et al.Spinal cord stimulation for the treatment of neuropathic pain:expert opinion and 5-year outlook[J].Expert Rev Med Devices,2020,17(12):1293~1302.