| ObjectiveThrough clinical case series studies and animal experiments,the effect and mechanism of the ultrasound-guided needle-knife releasing the transverse carpal ligament in the treatment of carpal tunnel syndrome(carpal tunnel syndrome,CTS)are discussed,which provides new research ideas and experimental basis for the clinical treatment of carpal tunnel syndrome.Method1.A case series study of ultrasound-guided needle-knife releasing the transverse carpal ligament in the treatment of CTS With a total of 18 CTS patients enrolled based on the diagnostic,inclusion and exclusion criteria,patients were treated by the ultrasound-guided needle-knife releasing the transverse carpal ligament in the previous study.The following examinations and scale filling were done before the treatment:(1)Electrophysiology for measuring patient SNCV,DML and CMAP amplitude;(2)Ultrasound imaging for testing median nerve flattening rate near the carpal tunnel and transverse ligament thickness;Stress-elastic imaging for observing changes in tissue stiffness in the carpal tunnel;(3)NRS score for assessing pain and numbness;(4)BCTQ for assessing functional status and symptom severity;(5)SF-36 for assessing living quality of patients.(1)(2)(3)items were checked and the scales were filled at 3 days after the treatment.Through telephone follow-up survey,(3)(4)(5)scales were completed at 1 month and 3 months after the treatment.Finally,the kelly criteria was used for the clinical efficacy evaluation.2.Modified animal model of rabbit carpal tunnel syndrome 24 New Zealand white rabbits were randomized into normal group(C group),glucose injection model group(N-M group)and ultrasound-guided injection model group(U-M group).With each group consisted of 8 rabbits,group C was untreated,and the N-M group was injected 0.1 ml of 10% glucose solution into the carpal tunnel from an open wound,while the U-M group was injected 0.3 ml of 10% glucose solution into the perimeter of the median nerve under ultrasound guidance.The two model groups were operated once a week for 4 times.Four samples were taken from each group in 1 week and 5 weeks after model grouping.Electrophysiological and ultrasound examinations were performed before sampling.Then HE staining and electron microscope were performed to observe the neuropathological changes.3.Surgical optimization of ultrasound-guided needle-knife releasing rabbit carpal tunnel syndrome Sixty 6-month New Zealand white rabbits were randomly divided into normal group(C),model group(M),ultrasound-guided needle-knife release 0.6mm-0°-1group(0.6mm-0°-1 group),ultrasound-guided needle-knife release 0.6mm-0°-2 group(0.6mm-0°-2 group),ultrasound-guided needle-knife release 0.6mm-5°-1 group(0.6mm-5°-1 group),ultrasound-guided needle-knife release 0.6mm-5°-2 group(0.6mm-5°-2 group),ultrasound-guided needle-knife release 0.8mm-0°-1 group(0.8mm-0°-1 group),ultrasound guided needle-knife release 0.8mm-0°-2 group(0.8mm-0°-2 group),ultrasound guided needle-knife release 0.8mm-5°-1 group(0.8mm-5°-1 group)and ultrasound guided needle-knife release 0.8mm-5°-2 group(0.8mm-5°-2group),together 10 groups of 6rabbits in each group.C group was untreated,and M group was modeled with the method of ultrasound-guided injection in the first part.The intervention group was treated with ultrasound-guided needle-knife release method with different needle-knife diameter,needle injection angles and release times.All samples were taken at 3 days after the intervention.Electrophysiology was applied to measure SNCV before sampling,and after sampling ELISA was applied to test IL-1 in the median nerve tissue of the carpal tunnel in each group.4.Impact of ultrasound-guided needle-knife releasing the transverse carpal ligament on the rabbit carpal tunnel syndrome Fifty 6-month New Zealand white rabbits were randomly divided into 5 groups: normal group(C group),model(M group),ultrasound-guided needle-knife release group(U group),non-ultrasound-guide d needle-knife release group(N group)and pseudo knife group(X group),with 10 rabbits in each group.Five samples were taken from each group at 3 days and 1 month after the intervention.Before sampling,Electrophysiology was applied to measure SNCV,DML and CMAP amplitudes,ultrasound examinations were performed to test median nerve diameter and TCL thickness,and ultrasonic stress elastography was used to assess the changes of the mechanical properties of carpal tunnel tissue.After sampling,histomorphological changes in the carpal tunnel were examined by HE staining,Masson staining and transmission electron microscopy.ELISA was used to test changes in the content of IL-1,IL-6,TNL-α,NGF and TGF-β1,b FGF,CTF and VEGF in median nerve and TCL tissues in different groups and at different time points.Western Blot and QPCR were used to detect Col 1 and Col 3 expression in median nerve and TCL tissues of each group.Results1.Clinical efficacy of ultrasound-guided needle-knife releasing the transverse carpal ligament in the treatment of CTS During ultrasound examinations,TCL thickness and median nerve flattening rate decreased at 3 days after the treatment(P <0.05).The pain intensity number score decreased significantly at 3 months after the treatment(P <0.05),and the numbness intensity number score decreased at 3 days,1 month,and 3 months after the treatment(P <0.05).In the Boston Carpal Tunnel Scale,the Symptom Severity Scale and Functional Status Scale improved significantly at 1 month and 3 months after the treatment(P<0.05).In the health status questionnaire,PF,BP,GH,and RE improved significantly at 1month and 3 months after the treatment(P <0.05),and SF and VT improved at 3 months after the treatment(P <0.05).2.Modified animal model of rabbit carpal tunnel syndrome During electrophysiological testing at 1 week after modeling,compared with C group and N-M group,SNCV,DML and CMAP amplitude in U-M group had significant difference(P <0.05);in 5weeks after modeling,SNCV,DML and CMAP amplitude between U-M group and C group had significant difference(P <0.05),which was statistically significant when compared with DML and CMAP in N-U group(P <0.05)and was more dysfunctional significant than the result at 1 week after modeling(P <0.05).The difference in CMAP amplitude between N-M group and C group was statistically significant(P <0.05),while others were of no difference(P> 0.05).In ultrasound testing,at 1 and 5 weeks after modeling,the median nerve diameter and transverse ligament thickness in the U-M group increased significantly compared with the C group and N-M group(P <0.05).Therefore,the modified model was chosen as the modeling method for the next study.3.Surgical optimization of ultrasound-guided needle-knife releasing rabbit carpal tunnel syndrome In electrophysiological examination,by comparing the effects of different needle-knife diameter,injection angles and cutting times on SNCV,it was revealed that the the fastest SNCV recovery was in 0.6mm-0°-1 and 0.8mm-5°-2 groups(P <0.05).In ELISA,it was revealed that the minimized content of IL-1 was in 0.6mm-0°-1 and0.8mm-5°-2 group(P <0.05)by comparing each group.There was no difference between the0.6mm-0°-1 group and the 0.8mm-5°-2 group(P> 0.05).For comprehensive analysis,ultrasound-guided needle-knife release treatment in the 0.6mm-0°-1 group was selected as the intervention method for the next research.4.Impact of ultrasound-guided needle-knife releasing the transverse carpal ligament on the rabbit carpal tunnel syndrome During electrophysiological examination at 3 days and 1 month after the intervention,SNCV and CMAP amplitudes increased significantly in U group(P <0.05),and DML shortened significantly 3 days after the intervention(P <0.05).N and X groups did not significantly improve neurological function(P> 0.05).During ultrasound examination at 3 days and 1 month after the intervention,neuroedema in U group significantly decreased(P <0.05),and TCL thickness decreased significantly 1 month after the intervention(P <0.05).There was no significant change in N and X groups(P> 0.05).HE staining showed that neural flattening rates improved in both the U and N groups at 1 month after the intervention(P <0.05).Serum ELISA test results showed that compared with C group,the contents of related inflammatory factors and fibrosis factors in M group increased significantly(P <0.05).Compared with M group,the contents of IL-1,IL-6,TNF-α,NGF,TGF-β1,CTGF and b FGF in U group decreased significantly(P <0.05),and the contents of NGF and CTGF in N group decreased(P <0.05).In the median nerve and TCL tissues,compared with group C,the contents of inflammatory factors and related fibrosis factors in M group increased significantly(P <0.05).In the median nerve tissue,compared with M group,the contents of IL-1,IL-6,TNF-α,NGF and b FGF,CTGF,VEGF,TGF-β1 in U group decreased significantly(P <0.05),and the contents of IL-6,b FGF,CTGF,and VEGF in N group decreased significantly(P <0.05).In TCL tissues,compared with M group,the contents of IL-1,IL-6,TNF-α,NGF,and b FGF,CTGF,VEGF,TGF-β1 in U group decreased significantly(P <0.05),while the contents of IL-1,IL-6,TNF-α,b FGF,and CTGF in N group decreased significantly(P <0.05).Western Blot test results showed that compared with C group,the expression of Col 1and Col 3 in M group increased significantly in the median nerve tissue(P <0.05).Compared with M group,the expression of Col 1 and Col 3 in both U and N groups decreased significantly(P <0.05),while the expression in the U group was lower than that of N group(P<0.05).In the TCL tissues,the expression of Col 1 and Col 3 in each group was not different(P> 0.05).QPCR test results showed that compared with C group,the expression of Col 1 and Col 3 in M group increased significantly in the median nerve and TCL tissues(P <0.05).In the median nerve tissue,compared with M group,the expression of Col 1 and Col 3 in both U and N groups decreased significantly(P <0.05).In the TCL tissue,the Col 1 expression did not change significantly after the intervention(P> 0.05),but the overall decline trend occurred.Compared with M group,the Col 3 expression in both U and N groups decreased significantly(P <0.05).Conclusion1.The ultrasound-guided needle-knife releasing the transverse carpal ligament in the treatment of CTS can significantly eliminate the symptoms of numbness and pain in patients,decrease the median nerve flattening rate and transverse carpal ligament thickness,restore hand function,and improve the living quality of patients.2.Compared with original modeling method,the method of four-time injection of 0.3ml10% glucose solution under ultrasound guidance can shorten the time required for the establishment of the disease model,and have high stability after the modeling,which is a simple and feasible model establishment method for rabbit carpal tunnel syndrome.3.The interaction of needle-knife diameter,needle injection angle and cutting times has obvious effects on the recovery of median nerve SNCV and the change of IL-1 content in rabbit carpal tunnel syndrome.By using the ultrasound-guided method with 0.6mm-diameter needle-knife to the 0°angle and releasing once,the recovery of SNCV can be promoted and the content of IL-1 can be decreased.4.By reducing injury,inflammatory response,and the changes of IL-1,IL-6,TNF-α and NGF content,changing the mechanical properties of the transverse carpal ligament,and lowering the expression of TGF-β1,b FGF,CTGF,VEGF,Col 1 and Col 3,the ultrasound-guided needle-knife releasing the transverse carpal ligament in the treatment of rabbit carpal tunnel syndrome plays its therapeutic role. |
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