Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Acta Anaesthesiol Scand. 2010 Apr;54(4):426-9. doi: 10.1111/j.1399-6576.2009.02186.x. Epub 2010 Jan 21.
Direct puncture by a needle is a risk factor for nerve damage. This investigation used scanning electron microscopy (SEM) to attempt to visualize the damage caused by different needles.
A 15 cm section of the tibial nerve was removed from the ankle of a patient undergoing below-the-knee amputation. The nerve specimen was punctured perpendicular to the fibers once by each of four needles: an insulated 22 G short-beveled (30 degrees), a 25 G long-beveled Quincke spinal needle, an 18 G Tuohy, and a 25 G Whitacre pencil point. The distal and proximal ends on either side of the needles were marked and the nerve was sectioned into 0.5 cm pieces. Each sample was preserved and then prepared for SEM. The needle tract was observed for evidence of mechanical damage at magnifications between x 47 and x 102 using SEM.
The epineurium, perineurium, fascicles, endoneurium, and vessels were identified in each sample. In both the short-beveled and the Whitacre samples, all fascicles along with the surrounding perineurium were intact. In both the Tuohy and the Quincke samples, obvious transection of fascicles and disruption of the perineurium were observed.
This investigation suggests that both the Tuohy and the Quincke needles may be more likely to cause trauma to the tibial nerve than either the short-beveled or the Whitacre needles.
直接用针穿刺是造成神经损伤的一个风险因素。本研究采用扫描电子显微镜（SEM）试图观察不同针造成的损伤。
从一位接受膝下截肢的患者踝部取出 15 厘米长的胫神经段。神经标本垂直于纤维用四根针各穿刺一次：一根绝缘的 22G 短斜面（30 度）、一根 25G 长斜面 Quincke 脊髓针、一根 18G Tuohy 针和一根 25G Whitacre 笔尖针。在针的远端和近端标记两侧，将神经切成 0.5 厘米长的小段。每个样本都保存下来，然后准备进行 SEM。用 SEM 在 x47 到 x102 之间的放大倍数观察针道是否有机械损伤的证据。
每个样本都能识别出神经外膜、神经内膜、束、神经内膜和血管。在短斜面和 Whitacre 样本中，所有束以及周围的神经内膜都是完整的。在 Tuohy 和 Quincke 样本中，明显观察到束的横断和神经内膜的破裂。
本研究表明，Tuohy 针和 Quincke 针比短斜面针和 Whitacre 针更有可能造成胫神经损伤。
