针刀松解对腕管综合征兔正中神经及腕横韧带的影响

doi:10.12122/j.issn.1673-4254.2025.11.08

摘要/Abstract

摘要：

目的探讨针刀松解腕横韧带对兔腕管综合征正中神经及腕横韧带的形态、功能、炎性因子水平的影响。方法成年新西兰兔30只，随机均分为对照组、模型组、超声组、非超声组、伪针刀组（n=6）。除对照组外均进行造模，造模7 d/次，共4次后，超声组使用超声引导下针刀松解腕横韧带，非超声组不使用超声进行松解，伪针刀组使用超声引导针刀到达腕横韧带但不进行松解。3组均使用针刀干预1次，干预后3、30 d分别每组取3只进行超声下腕横韧带及正中神经厚度检测、电生理检测、超声弹性成像检测及炎性因子水平检测。结果相较于模型组，超声组在干预后3、30 d均可显著降低腕横韧带与正中神经厚度，并改善感觉神经传导速度（P<0.05）。超声组腕横韧带弹性成像显示腕管内组织明显变软，且表现优于模型组、非超声组及伪针刀组。与模型组相比较，超声组介素-17（IL-17）水平在干预后30 d降低（P=0.013），且介素-6（IL-6）、前列腺素E₂水平均有下降。结论针刀松解腕横韧带可降低正中神经及腕横韧带厚度，提升正中神经功能，抑制腕管内组织刚度，下调腕管内炎性因子表达，超声组整体疗效优于非超声组。

关键词: 针刀松解, 腕管综合征, 腕横韧带, 正中神经, 超声引导

Abstract:

Objective To investigate the effect of needle knife release on median nerve (MN) and transverse carpal ligament (TCL) morphology and function and expression levels of inflammatory factors in rabbit models of carpal tunnel syndrome (CTS). Methods Thirty adult New Zealand rabbits were randomized equally into control group, CTS model group, ultrasound-guided needle knife release group, needle knife release group without ultrasound guidance, and sham treatment groups. In all but the control group, the rabbits were subjected to CTS modeling by 10% glucose solution injection into the carpal tunnel once a week for 4 consecutive weeks, followed by interventions with a single treatment session. At 3 days and 30 days after the interventions, 3 rabbits from each group were selected for ultrasound measurement of TCL and MN thickness, electrophysiological testing, ultrasound elastography, and inflammatory cytokine level assessment. Results In the rabbit models of CTS, ultrasound-guided needle knife release significantly reduced the thickness of TCL and MN and improved sensory nerve conduction velocity at both 3 and 30 days after the intervention. Elastography of the TCL showed markedly softened intra-carpal tissues after ultrasound-guided needle knife release and achieved superior outcomes over those in the other groups. The treatment also significantly reduced IL-17 levels and lowered IL-6 and PGE2 expression at 30 days after the intervention. Conclusion Needle knife release of the TCL reduces thickness of the MN and TCL, enhances median nerve function, alleviates intrascatic tissue stiffness, and downregulates inflammatory factors in the carpal tunnel in rabbit models of CTS, and ultrasound guidance further enhances its therapeutic efficacy.

Key words: needle-knife releas, carpal tunnel syndrome, transverse carpal ligament, median nerve, ultrasonic guidance

李蕴楠, 周俏吟, 罗申, 林伟霖, 黄馨瑶, 曹莹. 针刀松解对腕管综合征兔正中神经及腕横韧带的影响[J]. 南方医科大学学报, 2025, 45(11): 2358-2364.

Yunnan LI, Qiaoyin ZHOU, Shen LUO, Weilin LIN, Xinyao HUANG, Ying CAO. Effect of needle-knife release on the median nerve and transverse carpal ligament in rabbits with carpal tunnel syndrome[J]. Journal of Southern Medical University, 2025, 45(11): 2358-2364.

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参考文献 32

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Group	3 days	30 days
Control	0.03±0.017	0.05±0.005^△#
Model	0.05±0.008	0.06±0.011*^#
Ultrasound	0.03±0.006	0.05±0.011^△#
Non-ultrasound	0.04±0.004	0.06±0.006*^#
Sham treatment	0.05±0.007	0.06±0.008*^#
F/KW	12.680	10.083
P	<0.001	<0.001

Group	3 days	30 days
Control	0.03±0.017	0.05±0.005^△#
Model	0.05±0.008	0.06±0.011*^#
Ultrasound	0.03±0.006	0.05±0.011^△#
Non-ultrasound	0.04±0.004	0.06±0.006*^#
Sham treatment	0.05±0.007	0.06±0.008*^#
F/KW	12.680	10.083
P	<0.001	<0.001

Group	3 days	30 days
Control	0.06±0.014	0.06±0.005
Model	0.08±0.010*	0.07±0.009*^#
Ultrasound	0.06±0.014^△	0.06±0.017^△
Non-ultrasound	0.07±0.010*^△	0.07±0.008*^△#
Sham treatment	0.08±0.006*	0.08±0.008*
KW	44.167	35.941
P	<0.001	<0.001

Group	3 days	30 days
Control	0.06±0.014	0.06±0.005
Model	0.08±0.010*	0.07±0.009*^#
Ultrasound	0.06±0.014^△	0.06±0.017^△
Non-ultrasound	0.07±0.010*^△	0.07±0.008*^△#
Sham treatment	0.08±0.006*	0.08±0.008*
KW	44.167	35.941
P	<0.001	<0.001

Group	3 days	30 days
Control	50.87±4.46	41.00±1.98
Model	37.72±1.22*	34.60±3.29
Ultrasound	42.93±2.47^△	47.85±3.57^△
Non-ultrasound	49.43±3.59	37.42±2.34^#
Sham treatment	37.25±1.98*	40.14±2.30
F/KW	4.584	10.460
P	0.006	0.033