不同頻率電針刺激經矽膠管修護之截斷大鼠坐骨神經再生影響;The effects of different frequencies on regeneration of severed rat sciatic nerves repaired with silicone rubber chambers

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题名:	不同頻率電針刺激經矽膠管修護之截斷大鼠坐骨神經再生影響;The effects of different frequencies on regeneration of severed rat sciatic nerves repaired with silicone rubber chambers
作者:	何建宜;Chen-Yi Ho
贡献者:	中國醫藥大學：中國醫學研究所碩士班
关键词:	神經再生;矽膠神經管;電針;頻率;穴位;nerve regeneration;silicone rubber tube;electrical stimulation;frequency;acupoints
日期:	2006-06-20
上传时间:	2009-08-10 16:01:13 (UTC+8)
摘要:	周邊神經損傷時，神經截斷的長度、選用的神經結合術及採用的能量刺激源都與神經再生習習相關。在較短斷裂之神經修補大部分採用神經斷端直接接合術及神經束接合術，但若是截斷得神經太長時且無法直接連結神經斷端時，神經自體移植術及神經管接合術常被考慮使用。但由於在手術中取得捐贈神經的過程中容易發生危險及取得捐贈者神經時手術相當困難，神經自體移植術有很大的風險，所以利用人造神經管來修補截斷長距離的周邊神經已成為另一個選擇。周邊神經再生目前認為比較適合的方法就是利用神經管的接合，而神經管材質中常用的且在不同物理及化學因素影響下較穩定的就是矽膠管。一直以來在能量方面的探討，電針被廣泛討論且臨床上也常被使用於神經損傷後的復健治療。近來很多研究均發現使用低能量電流或在特定腧穴上施以電針刺激對受損周邊神經的再生有促進的效果。唯以上所提文獻結果均是非完全截斷之神經、小斷裂的神經、固定特定電流或特定頻率為研究目標，針對臨床上常見之大斷裂神經之修補及常採用不同頻率電針刺激治療方面無法提供完整的探討。本實驗以矽膠製神經管對老鼠之截斷坐骨神經做一接合，同時對此截斷長距離10 mm之神經斷端兩側腧穴同樣施與一電針刺激，其中設有一組對照組不施予電針及四組實驗組各組固定電流(1 mA)並配合不同的頻率1 Hz、2 Hz、20 Hz、200 Hz電針刺激穴位環跳穴(陽極)及陽陵泉穴(陰極)共五組。六週後，我們發現對照組、1 Hz、2 Hz、20 Hz、200 Hz的神經再生成功率分別為100 %、100 %、86 %、71 %、57 %，故推論電針頻率越高會抑制神經再生成功的情形，其中2 Hz以下神經再生成功率有統計上的顯著意義(p<0.05)。上述的結果再輔以神經電生理刺激、組織學切片及步態觀察等綜合分析，發現經矽膠管修護之截斷10 mm大鼠坐骨神經，使用電針頻率2 Hz可促進神經再生及神經功能恢復。 Nerve gap length、choosing what sort of nerve chamber、different stimulus are the most major cause for peripheral nerve regeneration. It is considered that end-to-end and the fascicular suture repair techniques are used while in a short nerve cleft. However if the nerve injury is extensive without recovery, forming an irreducible bridge between the injured proximal and distal stumps, a nerve graft or a nerve bridge is preferred. In the recent year , the best method of peripheral nerve regeneration is nerve conduit in connection to be generally acknowledged and silicone rubber is one of the most common materials while in chemical or physical environment used to make the bridging chambers because of its stable property. Electroacupuncture is generally discussed and apply on rehabilitation after nerver injury in energy area. Past work has demonstrated that a weak electric field or electrical field at some acupuncture points may influence mammalian peripheral nerve regeneration and guide nerve growth in the same direction . Unfortunately, nearly all these past literature only used a short nerve gap and certain current, thus the effect of electrical stimulation on nerve system may not be fully revealed. The purpose of this study is to determine whether different frequencies (1 Hz, 2 Hz, 20 Hz, 200 Hz and sham) of percutaneous electrical stimulation at acupoints of Huan Tiao(anode) and Yang Ling Chuan(cathode) could affect the regeneration of dissected rat sciatic nerve with a 10 mm gap in a silicone rubber tube. Six weeks after implantation, the success percentage of regeneration in 1 Hz, 2 Hz, 20 Hz, 200 Hz and sham were 100 %, 86 %, 71 %, 57 % and 100 % in order.The higher frequency of percutaneous electrical stimulation had the smaller success percentage of regeneration and the interesting finding is the frequency under 2 Hz electrical stimulation influences success significantly. (p<0.05) Moreover, based on the results of electrophysiology、morphologic and gait study, 2 Hz might be the best chosing in promoteing dissected rat sciatic nerve with a 10 mm gap in a silicone rubber tube.
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