Heat Production, Nerve Function, and Morphology following Nerve Close Dissection with Surgical Instruments
Heat Production, Nerve Function, and Morphology following Nerve Close Dissection with Surgical Instruments
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DOI：
10.1007/s00268-012-1471-x
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发表时间：
2012-02
影响因子：
2.6
通讯作者：
Johan Carlander;C. Koch;L. Brudin;C. Nordborg;O. Gimm;K. Johansson
中科院分区：
文献类型：
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作者：
Johan Carlander;C. Koch;L. Brudin;C. Nordborg;O. Gimm;K. Johansson
本研究的目的是比较超声激活的器械(US)、单极电刀和双极电刀(ES)在体内应用后对发热、神经功能和神经形态的影响。材料和方法使用US剪刀、单极电刀或双极剪刀在麻醉大鼠股二头肌的坐骨神经附近以标准化的方式纵向切断1 mm。用两个热电式微型传感器在同侧和对侧神经激活点1~4 mm范围内连续记录激活时间和温度。测量并计算达到最高温度的温升和达到最高温度的时间延迟，作为组织内热传播的表示，最高温度和热剂量(43℃下的等效暴露时间)。共进行了49项功能实验。远端记录肌电(EMG)电位。神经功能障碍被定义为诱发肌电幅度损失超过10%。结果双极ES的最大温升和热剂量明显高于US仪器(p=0.024，p=0.049)，而US仪器的结果差异较小。单极子的最高温度和热剂量较低，但发生了非常大的变化，可能是由于更多的随机电传播到地面电极和肌肉运动伪影。与双相和单相相比，功能丧失在美国组中最不常见，但并不显著。US组的中度和重度形态损害明显少于单极ES组(p=0.041)。我们发现最高温度与形态损伤或功能丧失的程度之间没有统计学意义的相关性。结论温度升高强烈依赖于距离激活的仪器的距离。两极ES剪刀产生的最高温度和热剂量比美国的变化更大。功能丧失和严重的形态损害在所有组中都不常见。
BackgroundThe aim of the present study was to compare an ultrasonically activated instrument (US), monopolar electrosurgery, and bipolar electrosurgery (ES) with respect to heat production, nerve function, and nerve morphology following in vivo application.Materials and methodsThe biceps femoris muscle of anesthetized rats was cut in a standardized manner longitudinally 1 mm adjacent to the sciatic nerve using US shears, a monopolar ES knife, or a bipolar ES scissors. Activation time and temperature were recorded continuously within 1–4 mm of the activation site ipsilateral and contralateral to the nerve with two thermoelectric microsensors. Temperature rise and time delay of reaching the temperature maximum, as an expression of heat spread within tissue, maximum temperature, and thermal dose (equivalent time of exposure at 43°C) were measured and calculated. A total of 49 functional experiments were conducted. The electromyographic (EMG) potential was recorded distally. Nerve dysfunction was defined as more than 10% loss of the evoked EMG amplitude. Forty-eight nerves were coded and submitted to blind histopathological examination, and morphological damage was graded on a 4-grade scale.ResultsThe maximum temperature elevation and the thermal dose were significantly higher for the bipolar ES compared with the US instrument (p= 0.024,p= 0.049), and with much less variation of results for the US instrument. The monopolar ES maximum temperature and thermal dose were lower, but a very large variation occurred, probably as a result of more random electrical spread to the ground electrode and muscle motion artifacts. Functional loss was least common in the US group—without being significant—compared to bipolar and monopolar ES. Moderate and severe morphological damage was significantly less common in the US group than in the monopolar ES group (p= 0.041). We found no statistically significant correlation between the highest temperatures and the degree of morphological damage or functional loss.ConclusionsThe temperature elevation depends strongly on the distance to the activated instrument. The bipolar ES scissors generates a higher maximum temperature and thermal dose with a greater variation in than the US. Functional loss and severe morphological damage were uncommon in all groups.