Zhang Ke, Xu Yujie, Yin Tianze, Ji Feng, Xu Hua
Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.
J Pain Res. 2025 Aug 14;18:4109-4121. doi: 10.2147/JPR.S535883. eCollection 2025.
Low temperature plasma radiofrequency ablation (LTPRA) has been widely applied for widespread clinical use in a variety of disciplines. However, the safe distance to act in the vicinity of neural tissue has not been determined.
Adult male Sprague-Dawley rats were subjected to LTPRA surgery performed at 0mm, 1mm and 2mm from the sciatic nerve or by cutting only the skin muscle to expose the sciatic nerve. Paw withdrawal thresholds (PWT) were determined at different time points, neurophysiology was examined, and the sciatic nerve was harvested for light and electron microscopic evaluation and Elisa for expression of proinflammatory cytokines and pain-related markers.
At 14 days postoperatively, both the 0mm and 1mm groups showed a decrease in PWT, a reduction in the peak amplitude of compound muscle action potentials (CMAPs), a decline in the number of Schwann cells, the area of myelin sheaths, and thinner myelin thickness, additionally, both groups exhibited upregulation of TNF-α, IL-1β, NGF, and C-fos in the sciatic nerve; furthermore, the 0mm group also exhibited slowed nerve conduction velocity, prolonged latency, and myelin vacuolization. The 2mm group exhibited transient reductions in PWT and elevated IL-1β and C-fos at 14 days, and all of these indicators fully recovered on postoperative day 28.
LTPRA causes only temporary and reversible changes 2 mm away from the sciatic nerve in rats, which can be recovered within 28 days. This study identifies a 2mm safety threshold for LTPRA to mitigate neurological sequelae, informing surgical guidelines.
低温等离子体射频消融术（LTPRA）已在多个学科中广泛应用于临床。然而，在神经组织附近进行操作的安全距离尚未确定。
将成年雄性Sprague-Dawley大鼠进行LTPRA手术，分别在距坐骨神经0mm、1mm和2mm处进行，或仅切开皮肤肌肉以暴露坐骨神经。在不同时间点测定爪部退缩阈值（PWT），检查神经生理学，并采集坐骨神经进行光镜和电镜评估，以及通过酶联免疫吸附测定法检测促炎细胞因子和疼痛相关标志物的表达。
术后14天，0mm组和1mm组均表现出PWT降低、复合肌肉动作电位（CMAP）峰值幅度减小、雪旺细胞数量减少、髓鞘面积减小和髓鞘厚度变薄，此外，两组坐骨神经中肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、神经生长因子（NGF）和C-fos均上调；此外，0mm组还表现出神经传导速度减慢、潜伏期延长和髓鞘空泡化。2mm组在术后14天时PWT短暂降低，IL-1β和C-fos升高，所有这些指标在术后第28天完全恢复。
LTPRA在大鼠坐骨神经2mm以外仅引起暂时且可逆的变化，可在28天内恢复。本研究确定了LTPRA减轻神经后遗症的2mm安全阈值，为手术指南提供了依据。
