Cleveland, Ohio From the Department of Plastic Surgery and the Department of Pathology, Case Western Reserve University.
Plast Reconstr Surg. 2013 May;131(5):1004-1012. doi: 10.1097/PRS.0b013e3182879ec2.
The aim of this study was to compare the incidence of neuroma formation and neuropathic pain following different techniques of nerve ablation in a rat sural nerve model.
Rat sural nerve was subjected to four different techniques of ablation with standardized creation of a 1-cm gap (n = 15 in each group). These included nerve avulsion, transection and burying in muscle, transection and folding of nerve, and transection alone. Animals were killed after 3 months. Explanted nerves were sectioned and stained with Masson trichrome and S-100 stain against neural tissue. The maximal neural cross-sectional area and neural-to-connective tissue ratio was quantified. Quantitative reverse-transcriptase polymerase chain reaction (n = 5) was used to analyze relative mRNA expression of ciliary neurotrophic factor and calcitonin gene-related peptide.
Neural cross-sectional area was statistically increased (p < 0.05) compared with controls in folded, muscle buried, and transected specimens but decreased in avulsed specimens. The neural-to-connective tissue ratio was statistically decreased in the avulsed group. Relative mRNA expression of ciliary neurotrophic factor was lowest in muscle buried (4 percent of control) (p < 0.05) and avulsed specimens (15 percent of control) (p < 0.05) and higher in folded (52 percent of control) and transected specimens (75 percent of control). Relative mRNA expression of calcitonin gene-related peptide was highest in folded specimens (302 percent of control) (p < 0.05).
Folding and transection lead to increased histologic evidence of neuroma formation, whereas folding leads to neuropathic pain, assayed by calcitonin gene-related peptide expression. Avulsion and muscle burying are preferable techniques for nerve ablation and inhibit nerve regeneration, evidenced by decreased ciliary neurotrophic factor expression. Avulsion offers an alternative to muscle burying when there is no muscle in the vicinity to bury the transected nerve.
本研究旨在比较大鼠腓肠神经模型中不同神经消融技术后神经瘤形成和神经病理性疼痛的发生率。
大鼠腓肠神经采用四种不同的消融技术进行处理，每组均建立 1cm 的间隙（每组 15 只）。这些技术包括神经撕脱、神经切断和埋入肌肉、神经折叠和切断以及单纯神经切断。3 个月后处死动物。取出的神经进行切片，用 Masson 三色法和 S-100 染色法对神经组织进行染色。对最大神经横截面积和神经与结缔组织比值进行定量分析。采用实时定量逆转录聚合酶链反应（n = 5）分析睫状神经营养因子和降钙素基因相关肽的相对 mRNA 表达。
与对照组相比，折叠、肌肉埋藏和切断标本的神经横截面积统计学上增加（p < 0.05），但撕脱标本的神经横截面积减少。撕脱组神经与结缔组织的比值统计学上降低。睫状神经营养因子的相对 mRNA 表达在肌肉埋藏组（4%对照组）（p < 0.05）和撕脱组（15%对照组）（p < 0.05）最低，在折叠组（52%对照组）和切断组（75%对照组）最高。降钙素基因相关肽的相对 mRNA 表达在折叠标本中最高（302%对照组）（p < 0.05）。
折叠和切断导致组织学上神经瘤形成的证据增加，而折叠导致降钙素基因相关肽表达增加，从而导致神经病理性疼痛。撕脱和肌肉埋藏是神经消融的首选技术，通过降低睫状神经营养因子的表达来抑制神经再生。当附近没有肌肉可以埋藏切断的神经时，撕脱是肌肉埋藏的替代方法。
