密歇根神经病变筛查表

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1、How to Use the Michigan Neuropathy Screening Instrument密歇根神经病变筛查表使用指南History 病史The history questionnaire is self-administered by the patient. Responses are added to obtain the total score. Responses of “yes” to items 1-3, 5-6, 8-9, 11-12, 14-15 are each counted as one point. A “no” response on items

2、 7 and 13 counts as 1 point. Item #4 is a measure of impaired circulation and item #10 is a measure of general aesthenia and are not included in scoring. To decrease the potential for bias, all scoring information has been eliminated from the patient version.病史调查表由病人自己填写，回答将计入其筛查总分中，1-3, 5-6, 8-9, 1

3、1-12, 14-15题每回答一个“是”将加1分，7和13题每回答一个“否”将加1分，4和10题不计分。为了减少潜在的误差，在病史调查表上将不出现得分信息。Physical Assessment 体格检查For all assessments, the foot should be warm (30C). 所有评估必须建立在足部温度30C的基础上Foot Inspection: The feet are inspected for evidence of excessively dry skin, callous formation, fissures, frank ulceration or

4、 deformities. Deformities include flat feet, hammer toes, overlapping toes, halux valgus, joint subluxation, prominent metatarsal heads, medial convexity (Charcot foot) and amputation.足部检查：足部检查的项目包括：足部皮肤干燥程度、胼胝体、龟裂、溃疡或畸形。畸形包括：扁平足、锤状趾、重叠趾、足外翻、关节半脱位、拇外翻、夏科特关节和截肢。Vibration Sensation: Vibration sensatio

5、n should be performed with the great toe unsupported. Vibration sensation will be tested bilaterally using a 128 Hz tuning fork placed over the dorsum of the great toe on the boney prominence of the DIP joint. Patients, whose eyes are closed, will be asked to indicate when they can no longer sense t

6、he vibration from the vibrating tuning fork. In general, the examiner should be able to feel vibration from the hand-held tuning fork for 5 seconds longer on his distal forefinger than a normal subject can at the great toe (e.g. examiners DIP joint of the first finger versus patients toe). If the ex

7、aminer feels vibration for 10 or more seconds on his or her finger, then vibration is considered decreased. A trial should be given when the tuning fork is not vibrating to be certain that the patient is responding to vibration and not pressure or some other clue. Vibration is scored as 1) present i

8、f the examiner senses the vibration on his or her finger for 10 seconds, 2) reduced if sensed for 10 or 3) absent (no vibration detection.)振动觉：振动觉应在大拇趾上检查，用128 Hz音叉放在大拇趾远端第一关节突起的上方进行双侧检查，同时病人闭起眼睛，这时再询问患者何时感觉不到音叉在振动了。通常，当患者不能感受到振动，而检查者把音叉放在自己示指上仍能感受到音叉振动超过10秒钟，那么就要考虑振动觉减退了，同时必须进行一个试验来证实受检者是否诚实反应确切的感受

9、而非受暗示，即使用未振动的音叉来检验。振动觉将被记录为1）正常检查者感觉音叉振动的时间10秒；2）减退 感觉音叉振动的时间10秒；3）缺失 受检者未察觉振动的存在。Muscle Stretch Reflexes: The ankle reflexes will be examined using an appropriate reflex hammer (e.g. Trommer or Queen square). The ankle reflexes should be elicited in the sitting position with the foot dependent and

10、the patient relaxed. For the reflex, the foot should be passively positioned and the foot dorsi-flexed slightly to obtain optimal stretch of the muscle. The Achilles tendon should be percussed directly. If the reflex is obtained, it is graded as present. If the reflex is absent, the patient is asked

11、 to perform the Jend-rassic maneuver (i.e., hooking the fingers together and pulling). Reflexes elicited with the Jendrassic maneuver alone are designated “present with reinforcement.” If the reflex is absent, even in the face of the Jendrassic maneuver, the reflex is considered absent.肌肉牵张反射：使用适当的反

12、射锤来检查踝反射，同时应在患者坐位、精神放松且足有依靠的情况下进行该检查。通过叩击跟腱如果反射出现则视为正常，如在强化措施(如：抓住脚趾来回拉动)下出现，则视为强化正常，如在强化措施下仍未出现则视为缺失。Monofilament Testing: For this examination, it is important that the patients foot be supported (i.e., allow the sole of the foot to rest on a flat, warm surface). The filament should initially be p

13、restressed (4-6 perpendicular applications to the dorsum of the examiners first finger). The filament is then applied to the dorsum of the great toe midway between the nail fold and the DIP joint. Do not hold the toe directly. The filament is applied perpendicularly and briefly, (1 second) with an e

14、ven pressure. When the filament bends, the force of 10 grams has been applied. The patient, whose eyes are closed, is asked to respond yes if he/she feels the filament. Eight correct responses out of 10 applications is considered normal: one to seven correct responses indicates reduced sensation and

15、 no correct answers translates into absent sensation.单丝检测：此检查的重点在于患者的足必须被有效的支撑，同时应休息在平坦和温暖的支撑物上。开始检查前应在患者的足背进行4-6次的预加应力。细丝的应用位置在甲褶和第一关节的中点。在细丝上加以垂直短暂且均匀的力，当细丝弯曲时对肢体产生的压力为10g。患者闭上眼睛开始检查，10次检查中患者能感到细丝8次则属于正常，1-7次感到细丝的存在则属于减弱，未感觉到细丝的压力则属于缺失。Patient Version患者版本MICHIGAN NEUROPATHY SCREENING INSTRUMENT密歇根

16、神经病变筛查表A. History (To be completed by the person with diabetes) 病史（由糖尿病患者亲自完成）Please take a few minutes to answer the following questions about the feeling in your legs and feet. Check yes or no based on how you usually feel. Thank you.请回答以下有关你下肢和足感觉的几个问题，在你日常感觉的基础上选择是或不是，非常感谢你的配合。1. Are you legs an

17、d/or feet numb? Yes No你的下肢或足部有麻木感吗？是 否2. Do you ever have any burning pain in your legs and/or feet? Yes No你的下肢或足部曾经有过灼痛的感觉吗？3. Are your feet too sensitive to touch? Yes No你的双足有感觉过敏的现象吗？4. Do you get muscle cramps in your legs and/or feet? YesNo你的下肢或双足出现过肌肉痛性痉挛的现象吗？5. Do you ever have any prickling

18、feelings in your legs or feet? Yes No你的下肢或双足出现过刺痛的感觉吗？6. Does it hurt when the bed covers touch your skin? Yes No当被褥接触皮肤时你有被刺痛的感觉吗？7. When you get into the tub or shower, are you able to tell the hot water from the cold water? 当你淋浴时，能清楚的感知水温的变化？ YesNo8. Have you ever had an open sore on your foot? Y

19、es No你曾经有过足部溃疡吗？9. Has your doctor ever told you that you have diabetic neuropathy? Yes No你的医生诊断过你患有糖尿病神经病变吗？10. Do you feel weak all over most of the time? Yes No你大部分时间会感到虚弱无力吗？11. Are your symptoms worse at night? Yes No你的症状在夜间是否会更严重？12. Do your legs hurt when you walk? Yes No你的下肢在走路时受过伤吗？13. Are

20、you able to sense your feet when you walk? Yes No你行走时能感觉到你的双足吗？14. Is the skin on your feet so dry that it cracks open? Yes No你足部的皮肤会因为太干燥而裂开吗？15. Have you ever had an amputation? Yes No你被进行过截肢手术吗？Total:总分：MICHIGAN NEUROPATHY SCREENING INSTRUMENT密歇根神经病变筛查表B. Physical Assessment (To be completed by h

21、ealth professional)体格检查（由医疗人员填写）1. Appearance of Feet足部外观检查Right 右Left左a. Normal 0 Yes 1 No Normal 0 Yes 1 No正常正常b. If no, check all that apply: If no, check all that apply:如有异常，检查下列项目如有异常，检查下列项目Deformities 畸形Deformities畸形Dry skin, callus 皮肤干燥，有胼胝Dry skin, callus皮肤干燥，有胼胝Infection 感染Infection感染Fissur

22、e 龟裂Fissure龟裂Other 其他Other其他specify: specify:详细说明：详细说明：Right右Left左Absent无 Present有Absent无 Present有2. Ulceration0 1 0 1溃疡Present/Present/Present Reinforcement Absent Present Reinforcement Absent正常强化正常缺失正常强化正常缺失3. Ankle Reflexes 0 0.5 1 0 0.5 1踝反射Present Decreased Absent Present Decreased Absent正常减弱缺失正常减弱缺失4. Vibration 0 0.5 1 0 0.5 1perception atgreat toe大拇趾振动觉5. Monofilament Normal Reduced Absent Normal Reduced Absent单丝压力觉正常减弱缺失正常减弱缺失0 0.5 1 0 0.5 1Signature: Total Score /10 Points签名：总分：