臺灣博碩士論文加值系統

雷射刺激穴位對截斷大鼠坐骨神經之再生作用
研究生：邱志文
指導教授：林昭庚
中國醫藥大學　中國醫學研究所
周邊神經斷傷後，復元時容易產生神經瘤，利用神經管接合修補術可改善此缺點。同時，亦可給予生化藥物或物理能量，刺激周邊神經斷端，加速再生。因生化藥物使用不便，帶有潛在危險，應用物理能量，便廣泛被研究。物理能量給予途徑，分穿皮和非穿皮。前者包括傳統針灸和電針；後者包括電場、電磁場、超音波、微波、放射線和雷射。傳統針灸和電針之刺激，對神經再生之療效，多為肯定。但穿皮刺激，接受者會感覺痛楚。兼且，其效力之檢測，亦因皮膚之參數，而難於分別為外加之能量或內在之震動。非穿皮刺激因此更被重視，尤以低能量雷射方式為優。以神經管接合術加非穿皮低能量雷射刺激周邊神經再生之文獻，報導不多。因此，本實驗計劃以30隻大鼠，在其右側坐骨神經幹截斷後，以矽膠管接合斷端，使管內空隙距離為10 mm。分3組 (對照組、5 kHz之低頻組、20 kHz之高頻組)，術後一星期，在大鼠實驗側之環跳穴和陽陵泉穴，隔天作低能量雷射刺激，每星期3次，共7星期。雷射期滿後，以傷口、毛色、行動、足趾、血尿和體重變化作觀察。再以電生理檢測、坐骨神經再生成功率之計算、脊髓神經細胞之測量、再生坐骨神經及腓腸肌之切片鏡檢和再生坐骨神經之組織學定量分析來評估。然後作統計，分析數據。結果，坐骨神經再生之成功率，受到雷射刺激之組別都比沒有雷射刺激之組別為低。而且，從電生理檢測及神經切片定性鏡檢來看，受到雷射刺激之再生神經纖維，傳導變慢及髓鞘品質變差。從神經切片定量分析來看，雷射刺激會減少神經軸突之平均面積。結論為雷射刺激穴位對截斷大鼠坐骨神經之再生有抑制作用。
關鍵詞：周邊神經再生、矽膠神經管、雷射

The Regeneration of Transected Rat Sciatic Nerve by Laser Stimulation on Acupuncture Points
Student：Chih-Wen Chiu
Professor：Jaung-Geng Lin
Institute of Chinese Medical Science, China Medical University
Post trauma of the peripheral nerve, neuroma will easily be associated during recovery. So the artificial neural tube technique is applied as the repair method. Meanwhile, biochemical substances or physical energy is used as the stimulator to accelerate the regeneration. Because of the inconvenience and the potential risk on using the biochemical substances, the effects of physical energy on the nerve regeneration are extensively been studied. Energy stimulation can affect the underline tissue through or on the skin. Through the skin method can be classified as traditional acupuncture and electro-acupuncture. On the skin method include electric field, electro-magnetic field, ultrasound, microwave, radiation or laser as an energy source. The effects of through the skin method are most been confirmed. But it may be associated with pain during stimulation. Also, the effect on nerve regeneration is hardly be recognized as simply by physical energy alone, maybe due to the pain inside the body. So on the skin stimulation is emphasized, especially the low energy laser effect. The literature of using the low energy laser stimulation on the peripheral nerve regeneration post neural tube connection is seldom been reported. Our experiment is planned with 30 rats, after their right sciatic nerves transected and connected by neural tube in 10 mm gap apart, laser stimulation is applied on two acupuncture points (Huan Tiao and Yang Ling Chuan) since one week later. The rats are divided into 3 groups: control, low frequency (5 kHz) and high frequency (20 kHz). The stimulation protocol is three times per week and totally with seven weeks. After the treatment period, the rats are studied in their external appearance: wound, skin, movement, digits, hematuria and body weight. Moreover, electro- physiology of the nerve conduction, successful rate of nerve regeneration, satellite motor neurons on corresponding spinal cord, gastrocnemius muscle under microscopy qualitatively, peripheral nerve under microscopy qualitatively and quantitatively are also be evaluated. Finally, these data is analysis statistically. The result is that the successful regeneration rate is decrease on the laser groups. Moreover, the myelination of the laser groups is poor in the study of electrophysiology and under microscopy examination. In the quantity analysis of the regenerated nerve, the mean axon area is decrease generally on the laser groups. The conclusion of the experiment is that laser- acupuncture on the transected rat sciatic nerve will suppress its regeneration.
Keywords: Peripheral nerve regeneration; Silicone neural tube; Laser.

目錄
第一章、前言------------------------------------------------- 1
第二章、文獻探討--------------------------------------------- 3
一、周邊神經損傷後之病理變化------------------------------ 3
1.1 周邊神經之正常結構---------------------------------- 3
1.2 周邊神經截斷後之變化-------------------------------- 4
1.3 周邊神經之再生方式---------------------------------- 5
二、西醫對周邊神經損傷後之處理---------------------------- 5
2.1 手術治療-------------------------------------------- 5
2.2 西藥治療-------------------------------------------- 6
三、中醫對周邊神經損傷後之治療---------------------------- 7
3.1 中醫之周邊神經概念---------------------------------- 7
3.2 中藥治療-------------------------------------------- 7
3.3 穴位治療-------------------------------------------- 8
四、能量刺激對神經再生之研究----------------------------- 8
4.1 穴位穿皮刺激---------------------------------------- 8
4.2 非穿皮能量刺激-------------------------------------- 8
五、雷射簡介---------------------------------------------- 11
5.1雷射定義-------------------------------------------- 11
5.2雷射原理-------------------------------------------- 11
5.3雷射分類-------------------------------------------- 11
5.4雷射特性-------------------------------------------- 11
5.5雷射功效-------------------------------------------- 12
六、周邊神經再生之動物模型及背景------------------------- 12
第三章、材料與方法------------------------------------------ 13
一、對象-------------------------------------------------- 13
二、材料-------------------------------------------------- 13
三、期間-------------------------------------------------- 15
四、分組-------------------------------------------------- 15
五、麻醉方式---------------------------------------------- 15
六、穴位選取---------------------------------------------- 15
七、流程-------------------------------------------------- 15
八、觀測與評估-------------------------------------------- 19
九、統計方法---------------------------------------------- 19
第四章、結果------------------------------------------------ 20
一、外觀-------------------------------------------------- 20
二、電生理檢測-------------------------------------------- 22
三、切片檢查---------------------------------------------- 23
四、脊髓神經細胞測量-------------------------------------- 28
五、再生坐骨神經之成功率---------------------------------- 28
六、再生坐骨神經之組織學定量分析-------------------------- 29
第五章、討論------------------------------------------------ 32
第六章、結論------------------------------------------------ 34
參考文獻--------------------------------------------------- 35
英文摘要--------------------------------------------------- 43
謝辭------------------------------------------------------- 45
圖目錄
圖3.1：低功率紅外線脈衝式雷射發送器------------------------- 13
圖3.2：氣體麻醉機------------------------------------------- 14
圖3.3：大鼠固定及雷射刺激----------------------------------- 16
圖4.1：對照組之神經幹橫切面(40X) --------------------------- 24
圖4.2：低頻組之神經幹橫切面(40X) --------------------------- 24
圖4.3：高頻組之神經幹橫切面(40X) --------------------------- 24
圖4.4：對照組之高倍神經束橫切面(400X) ---------------------- 25
圖4.5：低頻組之高倍神經束橫切面(400X) ---------------------- 26
圖4.6：高頻組之高倍神經束橫切面(400X) ---------------------- 26
圖4.7：對照組腓腸肌之橫切面(400X) -------------------------- 27
圖4.8：雷射組腓腸肌之橫切面(400X) -------------------------- 27
表目錄
表3.1：實驗分組--------------------------------------------- 15
表4.1：實驗動物之前後體重、外觀、血尿、存活及矽膠管變化情形-- 21
表4.2：電生理檢測結果--------------------------------------- 22
表4.3：電生理各項數值之比較及檢定結果----------------------- 23
表4.4：神經再生之成功率------------------------------------- 28
表4.5：組織學定量分析之結果--------------------------------- 30
表4.6：神經再生成功後之神經切片內含物數比較及檢定結果-------31

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