Boesch Jordyn M, Campoy Luis, Southard Teresa, Dewey Curtis, Erb Hollis N, Gleed Robin D, Martin-Flores Manuel, Sakai Daniel M, Sutton Jennifer, Williamson Baye, Zatroch Kathryn
Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA.
Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA.
Vet Anaesth Analg. 2019 Sep;46(5):689-698. doi: 10.1016/j.vaa.2019.05.006. Epub 2019 Jun 10.
Thermal radiofrequency (TRF) of the saphenous nerve (a sensory nerve) combined with pulsed radiofrequency (PRF) of the sciatic nerve (a sensory and motor nerve) might relieve intractable stifle osteoarthritis (OA) pain in dogs. The objective was to determine if saphenous nerve TRF induces Wallerian degeneration and if sciatic nerve PRF induces degeneration or dysfunction.
Blinded, controlled, randomized, preclinical study.
A group of six intact, female Beagle dogs aged 14-16 months.
In each dog, one pelvic limb was assigned randomly to the control group and the other to the treatment group. Dogs were anesthetized and, using ultrasonography, radiofrequency electrodes were positioned adjacent to saphenous and sciatic nerves bilaterally; TRF and PRF were performed only in the treatment limb. Motor nerve conduction velocity (MNCV) was measured in both sciatic nerves 2 weeks later, and the dogs were euthanized. Hematoxylin and eosin-stained sections of saphenous and sciatic nerves were examined using light microscopy. Degeneration and inflammation were scored 0 (none) to 3 (severe). A one-tailed, paired Wilcoxon signed-rank test was used to test for differences in scores and MNCV between control and treatment nerves.
Degeneration and inflammation scores were higher in treatment saphenous nerves in 5/6 dogs [83%; 95% confidence interval (CI), 36%, 99%]; however, after Bonferroni correction only degeneration score was higher (p = 0.0313). Degeneration, inflammation or decreased MNCV were not observed in sciatic nerves (each outcome: 0/6 nerves, 0%; 95% CI, 0%, 48%). No dogs experienced postprocedural pain or neurological deficits.
The degeneration in TRF-treated saphenous nerves appears sufficient to impair transmission. Sciatic nerve PRF did not cause degeneration with attendant motor deficits, consistent with a proposed neuromodulatory mechanism. A clinical trial is needed to confirm the combined techniques produce analgesia without motor deficits in dogs with stifle OA.
隐神经（一种感觉神经）的热射频（TRF）联合坐骨神经（一种感觉和运动神经）的脉冲射频（PRF）可能会缓解犬难治性膝关节骨关节炎（OA）疼痛。目的是确定隐神经TRF是否会诱导沃勒变性，以及坐骨神经PRF是否会诱导变性或功能障碍。
盲法、对照、随机、临床前研究。
一组6只14 - 16个月大的未绝育雌性比格犬。
在每只犬中，将一侧后肢随机分配至对照组，另一侧后肢分配至治疗组。犬只麻醉后，使用超声将射频电极双侧置于隐神经和坐骨神经附近；仅在治疗侧肢体进行TRF和PRF。2周后测量双侧坐骨神经的运动神经传导速度（MNCV），然后对犬实施安乐死。使用光学显微镜检查隐神经和坐骨神经苏木精 - 伊红染色切片。将变性和炎症评分为0（无）至3（严重）。采用单尾配对威尔科克森符号秩检验来检验对照组和治疗组神经在评分和MNCV方面的差异。
6只犬中有5只（83%；95%置信区间[CI]，36%，99%）治疗侧隐神经的变性和炎症评分更高；然而，经邦费罗尼校正后，仅变性评分更高（p = 0.0313）。坐骨神经未观察到变性、炎症或MNCV降低（每种结果：6条神经中0条，0%；95% CI，0%，48%）。没有犬出现术后疼痛或神经功能缺损。
TRF治疗的隐神经变性似乎足以损害神经传导。坐骨神经PRF未导致伴有运动功能缺损的变性，这与所提出的神经调节机制一致。需要进行一项临床试验来证实联合技术在患有膝关节OA的犬中产生镇痛效果且无运动功能缺损。
