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1、HowtoUsetheMichiganNeuropathyScreeningInstrument密歇根神经病变筛查表使用指南History病史Thehistoryquestionnaireisself-administeredbythepatient.Responsesareaddedtoobtainthetotalscore.Responsesof“yes”toitems1-3,5-6,8-9,11-12,14-15areeachcountedasonepoint.A“no”responseonitems7and13coun
2、tsas1point.Item#4isameasureofimpairedcirculationanditem#10isameasureofgeneralaestheniaandarenotincludedinscoring.Todecreasethepotentialforbias,allscoringinformationhasbeeneliminatedfromthepatientversion.病史调查表由病人自己填写，回答将计入其筛查总分中，1-3,5-6,8-9,11-12,14-15题每回答一个“是”将加1分，7
3、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。PhysicalAssessment体格检查Forallassessments,thefootshouldbewarm(>30°C).所有评估必须建立在足部温度>30°C的基础上FootInspection:Thefeetareinspectedforevidenceofexcessivelydryskin,callousformation,fissures,frankulcerationordeformities.Defo
4、rmitiesincludeflatfeet,hammertoes,overlappingtoes,haluxvalgus,jointsubluxation,prominentmetatarsalheads,medialconvexity(Charcotfoot)andamputation.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。VibrationSensation:Vibrationsensationshould
5、beperformedwiththegreattoeunsupported.Vibrationsensationwillbetestedbilaterallyusinga128HztuningforkplacedoverthedorsumofthegreattoeontheboneyprominenceoftheDIPjoint.Patients,whoseeyesareclosed,willbeaskedtoindicatewhentheycannolongersensethevibrationfromthevibratin
6、gtuningfork.Ingeneral,theexaminershouldbeabletofeelvibrationfromthehand-heldtuningforkfor5secondslongeronhisdistalforefingerthananormalsubjectcanatthegreattoe(e.g.examiner’sDIPjointofthefirstfingerversuspatient’stoe).Iftheexaminerfeelsvibrationfor10ormoresecondsonhi
7、sorherfinger,thenvibrationisconsidereddecreased.Atrialshouldbegivenwhenthetuningforkisnotvibratingtobecertainthatthepatientisrespondingtovibrationandnotpressureorsomeotherclue.Vibrationisscoredas1)presentiftheexaminersensesthevibrationonhisorherfingerfor<10seconds,2
8、)reducedifsensedfor³10or3)absent(novibrationdetection.)振动觉：振动觉应在大拇趾上检查，用128Hz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
