Takahashi Norimasa, Tasto James P, Ritter Mark, Ochiai Nobuyasu, Ohtori Seiji, Moriya Hideshige, Amiel David
Department of Orthopedic Surgery, University of California, San Diego, La Jolla, California 92093-0630, USA.
Am J Sports Med. 2007 May;35(5):805-10. doi: 10.1177/0363546506297085. Epub 2007 Jan 31.
Many patients with chronic tendinosis have experienced early pain relief after application of bipolar radiofrequency treatment. Pathologic nerve ingrowth or nerve irritation in the tendon has been considered as a possible cause of the pain experienced with tendinosis.
Bipolar radiofrequency treatment will ablate nerve fibers, resulting in pain relief.
Controlled laboratory study.
Eighteen Sprague-Dawley rats were used in this study. Eight rats were treated with 2 points of bipolar radiofrequency applications applied to the hind paws with the Topaz microdebrider device, 6 sham rats had a needle applied to the hind paws, and there were 4 control rats. Tissues were processed for neural class III beta-tubulin (TUJ-1) or calcitonin gene-related peptide (CGRP) immunohistochemistry by using the free-floating avidin-biotin complex technique. The numbers of TUJ1-immunoreactive and CGRP-immunoreactive nerve fibers in the epidermis were counted and compared with sham and control.
The number of nerve fibers demonstrated by both the antibodies of TUJ1 and CGRP were significantly decreased (P = .0002-.002) during the first 2 weeks after bipolar radiofrequency treatment. Macroscopically, the foot pad showed 2 dimples on the surface after bipolar radiofrequency treatment. Although it still showed a scar after 7 days, after 14 days it looked no different than the untreated contralateral control foot pad and foot pad of the sham group.
Bipolar radiofrequency treatment induced acute degeneration and/or ablation of sensory nerve fibers.
Degeneration or ablation of nerve fibers after bipolar radiofrequency treatment may explain the early postoperative pain relief after microtenotomy for tendinosis.
许多慢性肌腱病患者在接受双极射频治疗后早期疼痛得到缓解。肌腱中的病理性神经长入或神经刺激被认为是肌腱病疼痛的一个可能原因。
双极射频治疗将消融神经纤维,从而缓解疼痛。
对照实验室研究。
本研究使用了18只Sprague-Dawley大鼠。8只大鼠用Topaz微型清创器对后爪进行2点双极射频治疗,6只假手术大鼠后爪用针穿刺,4只为对照大鼠。采用游离漂片抗生物素蛋白-生物素复合物技术对组织进行神经III类β-微管蛋白(TUJ-1)或降钙素基因相关肽(CGRP)免疫组织化学处理。对表皮中TUJ1免疫反应性和CGRP免疫反应性神经纤维的数量进行计数,并与假手术组和对照组进行比较。
双极射频治疗后的前2周,TUJ1和CGRP抗体显示的神经纤维数量均显著减少(P = 0.0002 - 0.002)。宏观上,双极射频治疗后脚垫表面出现2个凹痕。虽然7天后仍有瘢痕,但14天后与未治疗的对侧对照脚垫和假手术组的脚垫无异。
双极射频治疗可导致感觉神经纤维急性变性和/或消融。
双极射频治疗后神经纤维的变性或消融可能解释了肌腱病微切开术后早期的疼痛缓解。