Sala-Blanch Xavier, Ribalta Teresa, Rivas Eva, Carrera Ana, Gaspa Albert, Reina Miguel A, Hadzic Admir
Departments of Anesthesiology, Hospital Clínic of Barcelona, Spain.
Reg Anesth Pain Med. 2009 May-Jun;34(3):201-5. doi: 10.1097/AAP.0b013e31819a2795.
Recent clinical reports suggest that intraneural needle placement may not always lead to neurologic injury. To explain the absence of neurologic complications in these reports, we studied the risk and extent of nerve injury after intentional needle-nerve placement in a cryopreserved human sciatic nerve.
The sciatic nerve was dissected from a cryopreserved cadaver through partial exposure. Needles were inserted through the nerve, using blunt-tip (30 degrees beveled) (group A) and sharp-tip (15 degrees beveled) (group D) needles. Five needle insertions were made for each needle type. Subsequently, transverse nerve sections at 10 needle trajectories were processed. Nerve samples were stained with hematoxylin-eosin, Masson trichromic, and immunohistochemical stains. In each section, the following variables were quantified: total number of fascicles and vessels in the immediate vicinity of the needle trajectories and the number of injured fascicles and vessels.
A total of 520 fascicles were quantified, of which 134 were in contact with the needle trajectories. The numbers of fascicles and vessels per section were 65 +/- 8 and 14 +/- 7, respectively. A mean of 16 +/- 5 fascicles were found in contact with the needle trajectory (group A: 17+/- 3, group D: 15 +/- 6). Of these, 4 fascicles (3.2%) and 1 intraneural vessel were found damaged in group D. No fascicular or vascular injuries were found in group A.
Our findings suggest that intraneural needle insertion may more commonly result in interfascicular rather than intrafascicular needle placement.
近期临床报告表明，神经内针刺入并不总是会导致神经损伤。为解释这些报告中未出现神经并发症的原因，我们研究了在冷冻保存的人坐骨神经中故意将针置于神经上后神经损伤的风险及程度。
通过部分暴露从冷冻保存的尸体上解剖出坐骨神经。使用钝头（30度斜面）针（A组）和尖头（15度斜面）针（D组）将针穿过神经。每种针型进行5次针刺。随后，对10个针道处的神经横切面进行处理。神经样本用苏木精-伊红、马松三色染色和免疫组织化学染色。在每个切片中，对以下变量进行量化：针道紧邻区域内的束状结构和血管总数以及受损束状结构和血管的数量。
共量化了520个束状结构，其中134个与针道接触。每个切片中束状结构和血管的数量分别为65±8和14±7。平均有16±5个束状结构与针道接触（A组：17±3，D组：15±6）。其中，D组发现4个束状结构（3.2%）和1条神经内血管受损。A组未发现束状结构或血管损伤。
我们的研究结果表明，神经内针刺入更常见的结果可能是针置于束间而非束内。
