Shibayama Masataka, Kuniyoshi Kazuki, Suzuki Takane, Yamauchi Kazuyo, Ohtori Seiji, Takahashi Kazuhisa
Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
J Hand Surg Am. 2014 Sep;39(9):1714-21. doi: 10.1016/j.jhsa.2014.05.026. Epub 2014 Jul 11.
Patients with idiopathic carpal tunnel syndrome are commonly treated by steroid injections into the carpal tunnel. We administered triamcinolone (Tr) to chronic constriction injury model rats. We hypothesized that Tr administration would have both favorable behavioral effects and quantifiable immunohistological effects on compressed nerves.
Thirty-six male Wister rats were used. For rats to be treated with Tr, we loosely ligated their right sciatic nerves at 4 sites. Sham rats had their nerves exposed without ligation. On postoperative day 7, we reexposed their ligated nerves, after which we delivered either 0.1 mg of Tr (0.1-mg group), 0.5 mg of Tr (0.5-mg group), or normal saline (saline group) around the nerve fibers at the injured sites. Gait was analyzed, and allodynia was assessed with von Frey hairs, before surgery and on postoperative days 3, 7, 10, 14, and 21. The right sciatic nerve was resected and stained using hematoxylin-eosin, and the fourth and fifth lumbar dorsal root ganglia (DRG) were removed and assessed by immunohistochemistry for calcitonin gene-related peptide (CGRP) and activating transcription factor 3 (ATF3) on postoperative day 21. In addition, interleukin-1β (IL-1β) in sciatic nerve was quantified using enzyme-linked immunosorbent assays.
Mechanical allodynia was significantly decreased in the 0.5-mg group compared with the saline group. In hematoxylin-eosin sections, the extent of inflammation-induced edema between the nerve fibers and infiltration of inflammatory cells was significantly reduced in the 0.5-mg group compared with the saline group. IL-1β levels at the sciatic nerve in the 0.5-mg group were significantly lower than those in the saline group.
Tr-treated chronic constriction injury rats exhibited significant alleviation of sensory disturbance, edema, inflammation, and pain-related peptide upregulation. These phenomena suggest the validity of Tr administration as a treatment affecting the nerve itself.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
特发性腕管综合征患者通常通过向腕管内注射类固醇进行治疗。我们对慢性压迫损伤模型大鼠给予曲安奈德（Tr）。我们假设给予Tr对受压神经会产生有利的行为学效应和可量化的免疫组织学效应。
使用36只雄性Wistar大鼠。对于接受Tr治疗的大鼠，我们在4个部位对其右侧坐骨神经进行松结扎。假手术大鼠的神经暴露但未结扎。术后第7天，再次暴露其结扎的神经，之后在损伤部位的神经纤维周围给予0.1mg Tr（0.1mg组）、0.5mg Tr（0.5mg组）或生理盐水（生理盐水组）。在手术前以及术后第3、7、10、14和21天分析步态，并用von Frey毛发评估痛觉过敏。术后第21天，切除右侧坐骨神经并用苏木精-伊红染色，取出第四和第五腰段背根神经节（DRG），通过免疫组织化学评估降钙素基因相关肽（CGRP）和激活转录因子3（ATF3）。此外，使用酶联免疫吸附测定法定量坐骨神经中的白细胞介素-1β（IL-1β）。
与生理盐水组相比，0.5mg组的机械性痛觉过敏明显减轻。在苏木精-伊红切片中，与生理盐水组相比，0.5mg组神经纤维之间炎症诱导的水肿程度和炎性细胞浸润明显减少。0.5mg组坐骨神经中的IL-1β水平明显低于生理盐水组。
Tr治疗的慢性压迫损伤大鼠的感觉障碍、水肿、炎症和疼痛相关肽上调明显减轻。这些现象表明给予Tr作为一种影响神经本身的治疗方法是有效的。
研究类型/证据水平：治疗性I。
