中国神经再生研究(英文版) ›› 2023, Vol. 18 ›› Issue (3): 683-688.doi: 10.4103/1673-5374.350215

• 原著:周围神经损伤修复保护与再生 • 上一篇    

超声波定位经皮神经刺激促进正中神经断裂后的功能恢复

  

  • 出版日期:2023-03-15 发布日期:2022-08-28
  • 基金资助:
    中国国家自然科学基金项目(81801787),中国博士后科学基金项目(2018M640238),天津市自然科学基金项目(20JCQNJC01690)

An ultrasound-guided percutaneous electrical nerve stimulation regimen devised using finite element modeling promotes functional recovery after median nerve transection

Xiao-Lei Chu1, #, Xi-Zi Song2, #, Yu-Ru Li3, Zi-Ren Wu3, Qi Li1, Qing-Wen Li3, Xiao-Song Gu2, *, Dong Ming2, 4, *   

  1. 1Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China; 2Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China; 3College of Exercise & Health Science, Tianjin University of Sport, Tianjin, China; 4College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
  • Online:2023-03-15 Published:2022-08-28
  • Contact: Xiao-Song Gu, PhD, nervegu@ntu.edu.cn; Dong Ming, PhD, richardming@tju.edu.cn.
  • Supported by:
    This work was supported by the National Natural Science Foundation of China, No. 81801787 (to XZS), China Postdoctoral Science Foundation, No. 2018M640238 (to XZS), the Natural Science Foundation of Tianjin, No. 20JCQNJC01690 (to XLC).

摘要:

皮下神经电刺激可促进和加速周围神经再生,并改善损伤神经的功能,且在皮下神经电刺激前使用超声波定位神经,有助于防止针灸过程中对神经的继发性损伤。但是目前对于刺激的相关参数还没有统一的标准。实验首先以有限元模型构建多层人体前臂模型,以电流密度和激活功能为优化指标,建立了皮下神经电刺激的最优方案,即两针相对角度为0°,电针距离为3cm,刺激电极位于神经损伤两侧。为检验这一方案的有效性,于天津医院康复科招募了正中神经断裂患者(n=23)进行临床随机对照试验验证。结果表明,与常规经皮电刺激相比,最优条件下的皮下神经电刺激治疗后,患者感觉功能、运动功能及握力均有明显提升。表明所设计的经皮神经刺激方案可显著改善正中神经横断损伤患者的感觉、运动和整体功能。

https://orcid.org/0000-0001-6764-4650 (Xiao-Song Gu); https://orcid.org/0000-0002-8192-2538 (Dong Ming); https://orcid.org/0000-0002-4302-5596 (Xiao-Lei Chu)

关键词: 周围神经损伤, 皮下神经电刺激, 经皮神经电刺激, 正中神经, 有限元模型, 神经再生, 随机对照试验, 神经康复

Abstract: Percutaneous electrical nerve stimulation of an injured nerve can promote and accelerate peripheral nerve regeneration and improve function. When performing acupuncture and moxibustion, locating the injured nerve using ultrasound before percutaneous nerve stimulation can help prevent further injury to an already injured nerve. However, stimulation parameters have not been standardized. In this study, we constructed a multi-layer human forearm model using finite element modeling. Taking current density and activated function as optimization indicators, the optimal percutaneous nerve stimulation parameters were established. The optimal parameters were parallel placement located 3 cm apart with the injury site at the midpoint between the needles. To validate the efficacy of this regimen, we performed a randomized controlled trial in 23 patients with median nerve transection who underwent neurorrhaphy. Patients who received conventional rehabilitation combined with percutaneous electrical nerve stimulation experienced greater improvement in sensory function, motor function, and grip strength than those who received conventional rehabilitation combined with transcutaneous electrical nerve stimulation. These findings suggest that the percutaneous electrical nerve stimulation regimen established in this study can improve global median nerve function in patients with median nerve transection.

Key words: finite element modeling, median nerve transection, nerve regeneration, neurorehabilitation, percutaneous electrical nerve stimulation, peripheral nerve injury, randomized controlled trial