Non-invasive Electrical Stimulation to Augment Human Peripheral Nerve Regeneration in Carpal Tunnel Syndrome

* 这是什么研究 *我们的研究是关于改善神经愈合。神经损伤非常常见，通常由创伤或神经压迫引起。虽然神经在受伤后会再生，但这个过程并不完美，人们通常会感到疼痛，麻木或虚弱。事实上，英国手外科学会最近将改善神经恢复列为手外科十大最重要的研究课题之一，我们对腕管综合征（CTS）特别感兴趣，这是一种由腕部正中神经压迫引起的神经损伤。CTS会导致手部疼痛和刺痛，以及拇指无力。大多数人需要手术来修复神经。CTS是非常常见的-高达十分之一的人会在他们的一生中发展CTS，腕管减压是英国最常见的手术之一。然而，许多人即使在成功的手术后也没有完全恢复。在CTS中改善神经再生和恢复的最有希望的治疗方法之一被称为电刺激。这种方法使用少量的电流来刺激神经。以前的所有研究都使用侵入性电刺激，在手术期间植入电极，并在手术后使用它们来刺激神经。这种方法并不理想，因为手术植入电极会带来额外的风险，并且手术后刺激神经需要在全身麻醉下进行腕管减压等简单手术。还有证据表明，手术前刺激神经比手术后刺激更能促进神经愈合。这项研究将是有史以来第一次对手术前应用的非侵入性刺激进行研究，这将克服这些局限性。* 这项研究的目的是什么？*我们想知道在腕管手术前对正中神经进行非侵入性电刺激是否有助于人们更好地恢复手部功能。回答这个问题需要我们更好地了解刺激过程中神经发生了什么，并最终进行一项大型研究，比较刺激和无刺激。* 这项研究将涉及哪些内容 *首先，我们计划完善通过皮肤刺激正中神经的技术。我们将根据核磁共振扫描图像制作手腕的计算机模型。我们将使用计算机模型来设计一种非侵入性刺激方案，该方案应产生与侵入性刺激相同的愈合效果。然后，我们将进行一项小型研究，在这项研究中，人们将在手术前接受真实的或假的（安慰剂）非侵入性刺激。我们将跟踪这些人六个月。这项小型研究的主要目的是确定一项更大规模的研究是否可行。我们感兴趣的是：-有多少人愿意参加-如果人们留在船上所有六个月-如果人们可以告诉他们是否有真实的或假刺激当然，我们也想看看是否有任何差异，手术后恢复组之间。我们将收集手术前后的症状和手部功能信息，以及神经功能的详细信息。我们还将在手术前后从手指上取一些皮肤样本，这将使我们能够观察神经是如何重新长入皮肤的。我们将寻找刺激组和假手术组在这些结果上的差异，这将有助于我们以后设计更大的研究。这项研究将帮助谁？*这项研究将帮助患有CTS和其他类型神经损伤的人，例如由事故，分娩过程中的创伤或癌症切除引起的神经损伤。使用计算机模型来理解神经反应将使其他研究人员能够针对特定类型的神经损伤进行完美的刺激，这是我们目前无法做到的。在临床上，我们的研究结果可以帮助许多治疗神经损伤的人，包括外科医生，神经学家和物理治疗师。

*What is this research about?*Our research is about improving nerve healing. Nerve injuries are very common, and typically caused by trauma or nerve compression. While nerves do regrow after injury, this process is not perfect and people are commonly left with pain, numbness, or weakness. In fact, the British Society for Surgery of the Hand recently identified improving nerve recovery as one of the top ten most important research topics in hand surgery.We are particularly interested in carpal tunnel syndrome (CTS), a nerve injury caused by compression of the median nerve at the wrist. CTS causes pain and tingling in the hand, and weakness of the thumb. Most people need surgery to decompress the nerve. CTS is very common - up to one in ten people will develop CTS in their lifetime, and carpal tunnel decompression is one of the commonest operations performed in UK. However, many people don't recover fully even after successful surgery. One of the most promising treatments to improve nerve regrowth and recovery in CTS is called electrical stimulation. This uses small amounts of electricity to stimulate the nerve.All previous research has used invasive electrical stimulation, implanting electrodes during surgery and using them to stimulate the nerve after the operation. This approach is not ideal as surgically implanting electrodes carries extra risks, and stimulating the nerve after the operation requires a simple operation like carpal tunnel decompression to be done under general anaesthetic. There is also evidence that stimulating the nerve before surgery promotes better nerve healing than post-operative stimulation. This study will be the first ever investigation into non-invasive stimulation applied before surgery, which would overcome these limitations. *What is the aim of this research?* We want to find out whether non-invasive electrical stimulation of the median nerve before carpal tunnel surgery helps people recover better function in their hands. Answering this question requires us to better understand what happens to the nerve during stimulation and eventually to run a large study comparing stimulation and no stimulation. *What will this research involve?*First, we plan to perfect techniques for stimulating the median nerve through the skin. We will make a computer model of the wrist from MRI scan images. We will use the computer model to design a non-invasive stimulation protocol which should produce the same healing effect as invasive stimulation. We will then run a small study in which people will receive either real or sham (placebo) non-invasive stimulation prior to their operation. We will follow these people for six months. The main aim of this small study is to determine if a larger study would be feasible. We are interested in:- How many people are willing to take part- If people stay on board for all six months- If people can tell whether they had the real or sham stimulationOf course, we also want to see if there are any differences in recovery after surgery between groups. We will collect information on symptoms and hand function before and after surgery, as well as detailed information on nerve function. We will also take small samples of skin from the finger before and after surgery, which will allow us look at how nerves regrow into the skin. We will look for differences in these outcomes between stimulation and sham groups, which will help us design a larger study afterwards.*Who will this research help?*This research will help people with CTS and other kinds of nerve injury, such as those caused by accidents, trauma during childbirth, or removal of cancers. Using computer models to understand nerve responses will allow other researchers to perfect stimulation for specific types of nerve injury, something we currently cannot do. Clinically, our results could help many people who treat nerve injuries, including surgeons, neurologists and physiotherapists.