脉冲射频和射频热凝术对臂丛神经损伤的病理学观察①.pdf

中国康复理论与实践2011 年11月第17卷第11期Chin J Rehabil Theory Pract, Nov. 2011, Vol. 17, No. 11 - 1003 - ·专题· 脉冲射频和射频热凝术对臂丛神经损伤的病理学观察① 公维义，苏建生，陈华，范崇玖，张良成 [摘要] 目的 探讨脉冲射频和射频热凝术致神经损伤的病理变化。方法 55 只Wistar 雄性大鼠，5 只为正常对照组(C 组) ， 另50 只暴露臂丛神经后随机分为脉冲射频组和射频热凝组，每组25 只。在术后即刻、1、7、14和28 d 取臂丛神行HE 染色及透射 电镜观察。结果 脉冲射频组术后神经功能正常，光镜下可见神经纤维间出现水肿，于术后1 d 最重，随后逐渐恢复。电镜下可见 髓鞘板层结构松散，并有髓鞘球形成，及超微结构的代偿性增生，并逐渐恢复。射频热凝组术后神经功能消失，并出现自噬行 为，镜下表现为沃勒变性和神经再生等改变。结论 脉冲射频和射频热凝术对神经均可产生损伤。脉冲射频损伤轻微，且恢复 快；射频热凝术则损伤严重，毁损神经恢复慢。 [关键词] 脉冲射频；射频热凝术；形态学；臂丛神经 Morphology of Brachial Plexus Nerve after Pulsed Radiofrequency and Radiofrequency Thermocoagulation in Rats GONG Wei-yi, SU Jian-sheng, CHEN Hua, et al. Department of Anesthesiology, Fujian Union Hospital, Fujian Medical University, Fuzhou 350001, Fuji- an, China Abstract: Objective To investigate the changes of morphology of injured nerve after pulsed radiofrequency (PRF) and radiofrequency thermocoagulation (RFTC) on rats. Methods 55 male Wistar rats were selected, in which 5 were allocated to control group (group C) and the other 50 were randomly divided into group PRF (n=25) and group RFTC (n=25). The specimens were analyzed both with light microsco- py and electron microscopy at immediate, and 1, 7, 14 and 28 d after operation. Results In group PRF, the nerve function of rats maintained after operation. The edema among nerve fibers was found under light microscope, while myelin lamellar structure disorder and myelin balls shaped, and compensatory hyperplasia of ultrastructure under electron microscopic level. Those effects were more pronounced 1 d after oper- ation. In group RFTC, the nerve function of rats disappeared and autophagy behaviors happened, meanwhile Wallers degeneration and nerve regeneration appeared