Name: an anatomical study of nerves at risk during minimally invasive hallux valgus surgery
Uploaded: 2018-02-17T13:00:00.000+00:00
Duration: 15 min 4 s
Description: Watch this Scientific Journal Video about An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery at JoVE.com

我们感谢巴塞罗那大学 Bellvitge 校园解剖室的技术人员, 他们提供了娴熟的帮助。我们感谢视听部门的工作与视频作为本出版物的一部分。我们感谢巴塞罗那大学医学系的捐赠者。

这项研究获得了机构伦理委员会 (Comissió de Bioètica) 的批准。解剖程序是由一个经验丰富的解剖学家进行的, 专门训练的平面解剖技术。这是确保实验结果成功的必要条件。
1. 准备
<ol><li>选择要包括在研究中的标本。使用膝下的尸体新鲜冰冻的人的脚。<ol>
<li>排除以下情况: 腿部、脚踝或脚部的任何畸形 (因为这可能影响神经的过程, 最终影响研究结果)、溃疡、疤痕或先前手术程序的明显迹象或任何其他可能神经的局部化困难。</li>
	</ol>
</li>
	<li>选择十不配对的脚 (五左和五右, 截肢的水平胫骨远端), 从高加索新鲜冰冻不 exsanguinated 标本;标本包括5名男性和5位年龄在80岁 (范围, 53-95) 岁的妇女。</li>
	<li>在室温自来水中解冻标本6-8 小时, 使样品解冻。不要使用热水, 因为它可能会改变样品的性质。</li>
	<li>准备解剖场。将标本放在解剖台上的无菌手术悬垂上。将标本放置在一个稳定的位置, 允许舒适地进入解剖区;最好使用支持, 使试样可以根据需要移动。</li>
	<li>准备与一些纱布垫一起使用的解剖器械, 在解剖过程中清洁田间。</li>
</ol>2. 解剖
<ol><li>用手术刀, 切开仅皮肤创造一个窗口大约 20 cm x 5 cm 在脚的内侧部分, 纵向地安置。开始15厘米近的第一 metatarso 指骨关节, 并结束5厘米远端, 大约。<ol>
<li>解剖皮肤不破坏皮下组织和避免任何神经结构的移位。每架飞机使用新的手术刀刀片。</li>
		<li>用手术刀的刀刃进行切口, 而不是面对标本。这遵循的原则之一, 平面解剖解剖皮肤。在这个步骤中使用齿钳紧紧握住皮肤。</li>
	</ol>
</li>
	<li>取下覆盖窗户区域的皮肤。如有必要, 使用纱布清洁解剖场。</li>
	<li>对皮下组织进行仔细的解剖, 以确定第一趾的背内侧和侧神经。使用无齿钳和新的手术刀刀片, 以避免损坏的结构所遇到的。虹膜剪刀和 periosteotome 有助于在解剖的地方, 神经被发现 (但仍然不可见) 的进展, 因为他们允许一个较不积极的解剖和防止损伤神经。</li>
	<li>在窗户的下部解剖, 避免无意中切断神经。识别神经而不脱离皮下组织的下部, 以防止移位。一旦每个神经被辨认, 解剖通过它的路线直到第一个 metatarso 指骨联合。</li>
	<li>把神经放在最初的位置, 就第一 metatarso-指骨关节, 用针刺穿神经和第一跖趾关节关节线。</li>
	<li>执行第一趾的手动牵引, 使连接线的位置在第一跖骨的头和第一趾的近方阵的底部之间是明显的。针必须先刺穿神经, 然后引入 metatarso 指骨关节。这一步确保神经在关节方面的位置在整个研究中都是稳定的。</li>
</ol>3. 冻结
<ol><li>用气泡包装和胶带保护每个试样, 避免冷烧。在包装过程中要小心, 不要移动持有神经的针头。</li>
	<li>适当地标记每个标本。</li>
	<li>在-17 摄氏度和-20 摄氏度之间将标本引入冷冻室。</li>
	<li>在执行协议的下一步之前, 请等待至少6小时 (或一夜) 的样本冻结。</li>
</ol>4. 锯切
<ol><li>检查锯切设备。使用带有水冷系统的金刚石锯。</li>
	<li>准备工作领域的标本将纵后的部分。</li>
	<li>打开水流, 开始锯旋转。调整锯的切割速度和冷却的水流。</li>
	<li>一旦冻结, 把标本放在锯板上。调整1厘米后的 metatarso 指骨关节的切割线, 因为这是有关手术切口放置的点。在标本从冰箱中取出后立即执行该部分, 以避免解冻。</li>
	<li>将水流降到最低, 以保护试样不因锯的摩擦而燃烧, 同时避免用水解冻试样, 以及随后的解剖结构改变。</li>
	<li>第一节结束后, 丢弃标本的前块 (含脚趾)。</li>
	<li>执行第二部分。做一个平行的切口, 1 厘米后的第一个, 以获得一个1厘米厚的块。这是标准厚度, 因为较薄的部分可能会导致结构从原始路径移动。</li>
	<li>放弃其余的标本或保存进一步的研究。这些标本可以通过浸泡在固定液中解冻或修复。</li>
</ol>5. 测量
<ol><li>将切片块平放在工作台上, 并将量角器平放在切割试样的表面上。</li>
	<li>使用标准量角器与中心位于第一跖骨骨干中心。在伸趾肌腱的内侧边界的轴之一, 背。</li>
	<li>使用量角器的第二轴测量第一趾的背内侧和侧神经的位置。</li>
	<li>将测量结果推断为时钟模型, 球体是第一跖骨骨干的轮廓。</li>
</ol>

<ol>
	<li>Perera, A. M., Mason, L., Stephens, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+pathogenesis+of+hallux+valgus.">The pathogenesis of hallux valgus.</a> J Bone Joint Surg. 93 (17), 1650-1661 (2011).</li><li>Lucas, Y., Hernandez, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+moderate+hallux+valgus+by+percutaneous,+extra-articular+reverse-L+Chevron+(PERC)+osteotomy.">Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy.</a> Bone Joint J. 98B (3), 365-373 (2016).</li><li>Malagelada, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increasing+the+safety+of+minimally+invasive+hallux+surgery-An+anatomical+study+introducing+the+clock+method.">Increasing the safety of minimally invasive hallux surgery-An anatomical study introducing the clock method.</a> Foot Ankle Surg. , 10-14 (2016).</li><li>Golan&#243;, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anatomy+of+the+ankle+ligaments:+A+pictorial+essay.">Anatomy of the ankle ligaments: A pictorial essay.</a> Knee Surg Sports Traumatol Arthrosc. 18 (5), 557-569 (2010).</li><li>Dalmau-Pastor, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extensor+apparatus+of+the+lesser+toes:+anatomy+with+clinical+implications--topical+review.">Extensor apparatus of the lesser toes: anatomy with clinical implications--topical review.</a> Foot Ankle Int. 35 (10), 957-969 (2014).</li><li>Dalmau-Pastor, M., Yasui, Y., Calder, J. D., Karlsson, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anatomy+of+the+inferior+extensor+retinaculum+and+its+role+in+lateral+ankle+ligament+reconstruction+a+pictorial+essay.">Anatomy of the inferior extensor retinaculum and its role in lateral ankle ligament reconstruction a pictorial essay.</a> Knee Surg Sports Traumatol Arthrosc. 24 (4), 957-962 (2016).</li><li>Vesalius, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> De humanis corporis fabrica libris septem. , (1543).</li><li>Dalmau-Pastor, M., Vega, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Letter+Regarding+Cadaveric+Analysis+of+the+Distal+Tibiofibular+Syndesmosis.">Letter Regarding Cadaveric Analysis of the Distal Tibiofibular Syndesmosis.</a> Foot Ankle Int. 38 (3), 343-345 (2017).</li><li>Caraballo, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vascular+Structures+of+the+Lateral+Wall+of+the+Maxillary+Sinus:+A+Vascular+Labeling+Technique.">Vascular Structures of the Lateral Wall of the Maxillary Sinus: A Vascular Labeling Technique.</a> Implant Dent. 26 (1), 153-157 (2017).</li><li>Golan&#243;, P., Vega, J., P&#233;rez-Carro, L., G&#246;tzens, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ankle+Anatomy+for+the+Arthroscopist.+Part+I:+The+Portals.">Ankle Anatomy for the Arthroscopist. Part I: The Portals.</a> Foot Ankle Clin. 11 (2), 253-273 (2006).</li><li>Golan&#243;, P., Vega, J., P&#233;rez-Carro, L., G&#246;tzens, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ankle+Anatomy+for+the+Arthroscopist.+Part+II:+Role+of+the+Ankle+Ligaments+in+Soft+Tissue+Impingement.">Ankle Anatomy for the Arthroscopist. Part II: Role of the Ankle Ligaments in Soft Tissue Impingement.</a> Foot Ankle Clin. 11 (2), 275-296 (2006).</li></ol>

作者没有与这项研究相关或影响的金融利益的竞争。

本研究所用方法的基础是断层解剖和解剖平面解剖的结合, 因为它在历史上已经被实践了7。这不仅要求解剖学知识, 而且需要具体的训练, 什么是时间苛刻的技术, 极大地依赖于刀的技能。因此, 解剖学教科书或科学论文中提供的一些解剖学图像, 特别是在骨科手术领域, 缺乏准确性, 对外科医生执行尖端技术没有足够的指导意义, 比如微创程序。因此, 文献中建议, 应在专家、外科?...

拇外翻是一种常见的病理影响第一趾, 其中近方阵是横向偏离, 而第一跖骨是偏离内侧1。经皮穿刺或微创手术 (MIS) 技术的拇外翻是这一学科的第一个描述, 许多研究报告他们的好处, 但也有其风险2。拇外翻错误矫正涉及截骨术通过小切口使用特定的手术器械进行。鉴于未进行开放性解剖, 神经血管结构损伤的风险高于开放手术时的识别。此外, 与任何外科手术一样, 病人和外科医生在手术台周围的定位远不像经典解剖书籍或论文中描述的解剖位置。
拇外翻手术危险的神经结构是大脚趾的背内侧神经, 腓浅神经的分支, 大脚趾的侧神经, 腓深神经的分支。本研究的目的是描述这些神经的位置, 对于拇趾手术切口使用, 并说明了一种新的方法, 容易重现的手术条件。此外, 还介绍了使用经皮器械的安全门户。
在任何外科领域, 特别是在微创过程中, 全面的解剖学知识是必不可少的。新的外科和影像学技术的发展需要对解剖地标的二维和三维定位有新的认识。以前报告的解剖解剖技术是由我们的团队开发的, 以克服传统解剖技术的局限性3,4,5,6和这里被应用于重现与治疗拇外翻 (高压) 和层 (HR) 病理的 MIS 程序相对应的皮肤切口和仪表入口入口。因此, 该方法适用于从传统的开放式手术到 MIS3,4,5,6的外科技术。

<table><tbody><tr><td>Adson Non-Toothed dissection forceps</td><td>Bontempi</td><td>BD-31</td><td></td></tr><tr><td>Adson Toothed dissection forceps</td><td>Bontempi</td><td>BD-30</td><td></td></tr><tr><td>Surgical scalpel handle n&amp;ordm; 4</td><td>Swann-Morton</td><td>4</td><td></td></tr><tr><td>Surgical scalpel blades n&amp;ordm; 24</td><td>Swann-Morton</td><td>24</td><td>&lt;em&gt;Ad libitum&lt;/em&gt;</td></tr><tr><td>Iris scissors- curved</td><td>Bontempi</td><td>FG-2</td><td></td></tr><tr><td>Periostotome P-24</td><td>Bontempi</td><td>718-24G</td><td></td></tr><tr><td>Intramuscular 23G sterile needles</td><td>Totclinic</td><td>23</td><td>&lt;em&gt;Ad libitum&lt;/em&gt;</td></tr><tr><td>Goniometer</td><td></td><td></td><td></td></tr><tr><td>Latex gloves</td><td></td><td></td><td>&lt;em&gt;Ad libitum&lt;/em&gt;</td></tr><tr><td>Gauze pads</td><td></td><td></td><td>&lt;em&gt;Ad libitum&lt;/em&gt;</td></tr><tr><td>Non-Sterile surgical drape</td><td></td><td></td><td></td></tr><tr><td>Saw</td><td>EXAKT Advanced Technologies GmbH</td><td>EXAKT 312 Pathology Saw</td><td></td></tr></tbody></table>

an anatomical study of nerves at risk during minimally invasive hallux valgus surgery

微创外科 (MIS) 程序的日益普及, 使得有必要新的解剖学参考, 以帮助在立体定位和定位的结构, 不直接可见的外科医生。这对于像神经或血管这样危险的结构尤为重要。最优化的尸体处理材料和多种技术的结合, 以弥补有限的可用性标本。该协议结合解剖平面解剖和新鲜冷冻标本的断层解剖, 帮助本地化相关结构, 如神经, 动脉, 静脉和正确定位的门户在 MIS 程序。解剖教科书中对这些结构的描述与手术领域所遇到的不同;由于这个原因, 需要新的解剖学研究与外科的方向。然而, 这是一个复杂的, 耗时的技术, 需要具体的培训。用所谓的 "时钟方法" 描述的解剖学参考资料为外科医生提供了一个简单而又可重复的系统, 用于在拇外翻 MIS 程序中找到危险神经的路径。该模型可推断为许多其他微创手术程序。

使用时钟方法, 背内侧和侧神经一直被发现在10和2点之间 (图1)。背内侧神经被发现在平均26.2°内侧在弹流润滑的内侧边界, 对应于一个区域在12和2点之间在右脚, 并且在10和12点之间在左脚。侧神经是32.3°侧向内侧边界的弹润滑平均, 这相当于一个区域之间的12和2点左脚, 并在10和12点之间的右脚。
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Watch this Scientific Journal Video about An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery at JoVE.com

An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery

微创拇外翻手术中神经风险的解剖学研究

微创外科 (MIS) 程序依赖于解剖学上的参考, 以定位结构不直接可见的外科医生。本手稿描述了一种联合的方法, 平面解剖和切片解剖的新鲜冰冻标本, 以确定风险结构在 MIS 程序。

The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional ...

an-anatomical-study-nerves-at-risk-during-minimally-invasive-hallux

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

11.6K 次观看.  University of Barcelona. 微创外科 (MIS) 程序依赖于解剖学上的参考, 以定位结构不直接可见的外科医生。本手稿描述了一种联合的方法, 平面解剖和切片解剖的新鲜冰冻标本, 以确定风险结构在 MIS 程序。

视频: An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery

The Spared Nerve Injury (SNI) Model of Induced Mechanical Allodynia in Mice

Peripheral neuropathic pain is a severe chronic pain condition which may result from trauma to sensory nerves in the peripheral nervous system. The spared nerve injury (SNI) model induces symptoms of neuropathic pain such as mechanical allodynia i.e. pain due to tactile stimuli that do not normally provoke a painful response [1]. 
The SNI mouse model involves ligation of two of the three branches of the sciatic nerve (the tibial nerve and the common peroneal nerve), while the sural nerve is left intact [2]. The lesion results in marked hypersensitivity in the lateral area of the paw, which is innervated by the spared sural nerve. The non-operated side of the mouse can be used as a control. The advantages of the SNI model are the robustness of the response and that it doesn&#x2019;t require expert microsurgical skills.
The threshold for mechanical pain response is determined by testing with von Frey filaments of increasing bending force, which are repetitively pressed against the lateral area of the paw [3], [4]. A positive pain reaction is defined as sudden paw withdrawal, flinching and/or paw licking induced by the filament. A positive response in three out of five repetitive stimuli is defined as the pain threshold. 
As demonstrated in the video protocol, C57BL/6 mice experience profound allodynia as early as the day following surgery and maintain this for several weeks.

The Spared Nerve Injury SNI Model of Induced Mechanical Allodynia in Mice

The Spared Nerve Injury animal model is described here as a mouse model of peripheral neuropathic pain following partial denervation of the sciatic nerve by lesioning the tibial and common peroneal nerve branches, leaving the remaining sural nerve intact. Behavioral modification resulting from mechanical allodynia is quantified by von Frey filaments.

幸免神经损伤（SNI）模型引起的机械触感小鼠

Peripheral neuropathic pain is a severe chronic pain condition which may result from trauma to sensory nerves in the peripheral nervous system. The spared ...

科研

医学

The Fibular Nerve Injury Method: A Reliable Assay to Identify and Test Factors That Repair Neuromuscular Junctions

The neuromuscular junction (NMJ) undergoes deleterious structural and functional changes as a result of aging, injury and disease. Thus, it is imperative to understand the cellular and molecular changes involved in maintaining and repairing NMJs. For this purpose, we have developed a method to reliably and consistently examine regenerating NMJs in mice. This nerve injury method involves crushing the common fibular nerve as it passes over the lateral head of the gastrocnemius muscle tendon near the knee. Using 70 day old female mice, we demonstrate that motor axons begin to reinnervate previous postsynaptic targets within 7 days post-crush. They completely reoccupy their previous synaptic areas by 12 days. To determine the reliability of this injury method, we compared reinnervation rates between individual 70 day old female mice. We found that the number of reinnervated postsynaptic sites was similar between mice at 7, 9, and 12 days post-crush. To determine if this injury assay can also be used to compare molecular changes in muscles, we examined levels of the gamma-subunit of the muscle nicotinic receptor (gamma-AChR) and the muscle-specific kinase (MuSK). The gamma-AChR subunit and MuSK to are highly upregulated following denervation and return to normal levels following reinnervation of NMJs. We found a close relationship between transcript levels for these genes and innervation status of muscles. We believe that this method will accelerate our understanding of the cellular and molecular changes involved in repairing the NMJ and other synapses.

We have developed a nerve injury method to reliably examine muscle reinnervation, and thus regeneration of neuromuscular junctions in mice. This technique involves injuring the common fibular nerve via a simple and highly reproducible surgery. Muscle reinnervation in then assessed by whole-mounting the extensor digitorum longus muscle.

腓神经损伤方法:可靠检测，以确定和测试因素修复神经肌肉接头

The neuromuscular junction (NMJ) undergoes deleterious structural and functional changes as a result of aging, injury and disease. Thus, it is imperative ...

神经科学

Stromal Vascular Fraction-enriched Fat Grafting for the Treatment of Symptomatic End-neuromata

The purpose of this study was to methodically illustrate and highlight the crucial steps of stromal vascular fraction (SVF)-enriched fat grafting as a novel treatment of symptomatic end-neuromata of peripheral sensory nerves, and in this study, specifically of the superficial branch of the radial nerve (SBRN). Despite a multitude of existing treatments, persistent postoperative pain and common pain relapse are still very common, independent of the procedure assessed. The neuroma is microsurgically excised accordingly to standardized protocol. Instead of the relocation of the regenerating nerve stump in neighboring anatomical structures, such as muscle or bone, a fat graft is applied perifocally and acts as a mechanical barrier. In order to reduce the fat resorption rate and boost the regenerative potential of the graft, the highly concentrated SVF is integrated in the grafting. The SVF is isolated from subcutaneous fat by enzymatic and mechanic separation of the lipoaspirate by a specific commercial isolation system. The SVF-enriched fat graft provides both a mechanical barrier and various biological effects at the cellular level, including improving angiogenesis, inflammation, and fibrosis. Both mechanical and biologic effects help to reduce the disorganized axonal outgrowth of the nerve stump during nerve regeneration and hence prevent the recurrence of painful end-neuromata.

The purpose of the study is to illustrate the technical procedure of stromal vascular fraction (SVF)-enriched fat grafting as a novel treatment of symptomatic end-neuromata. This technique provides advantages of both the mechanical barrier and the biological action at the cellular level by the processed and concentrated SVF.

基质血管部分富集脂肪移植治疗症状性端 neuromata

The purpose of this study was to methodically illustrate and highlight the crucial steps of stromal vascular fraction (SVF)-enriched fat grafting as a ...

Ethanol-Induced Cervical Sympathetic Ganglion Block Applications for Promoting Canine Inferior Alveolar Nerve Regeneration Using an Artificial Nerve

Polyglycolic acid collagen (PGA-C) tubes are bio-absorbable nerve tubes filled with collagen of multi-chamber structure, which consist of thin collagen films. Favorable clinical outcomes have been achieved when using these tubes for the treatment of damaged inferior alveolar nerve (IAN). A critical factor for the successful nerve regeneration using PGA-C tubes is blood supply to the surrounding tissue. Cervical sympathetic ganglion block (CSGB) creates a sympathetic blockade in the head and neck region thus increasing blood flow in the area. To ensure an adequate effect, the blockade must be administered with local anesthetics one to two times a day for several consecutive weeks; this poses a challenge when creating animal models for investigating this technique. To address this limitation, we developed an ethanol-induced CSGB in a canine model of long-term increase in blood flow in the orofacial region. We examined whether IAN regeneration via PGA-C tube implantation can be enhanced by this model. Fourteen Beagles were each implanted with a PGA-C tube across a 10-mm gap in the left IAN. The IAN is located within the mandibular canal surrounded by bone, therefore we chose piezoelectric surgery, consisting of ultrasonic waves, for bone processing, in order to minimize the risk of nerve and vessel injury. A good surgical outcome was obtained with this approach. A week after surgery, seven of these dogs were subjected to left CSGB by injection of ethanol. Ethanol-induced CSGB resulted in improved nerve regeneration, suggesting that the increased blood flow effectively promotes nerve regeneration in IAN defects. This canine model can contribute to further research on the long-term effects of CSGB.

We evaluated the effect of cervical sympathetic ganglion block on nerve repair using artificial nerve conduits. Male beagle dogs were each implanted with an artificial nerve across a 10-mm gap in the left inferior alveolar nerve; left cervical sympathetic ganglion was blocked by injecting 99.5% ethanol via lateral thoracotomy.

乙醇诱导的颈椎交交型神经节阻滞在促进犬下肺泡神经再生中的应用

Polyglycolic acid collagen (PGA-C) tubes are bio-absorbable nerve tubes filled with collagen of multi-chamber structure, which consist of thin collagen ...

Functional and Physiological Methods of Evaluating Median Nerve Regeneration in the Rat

The main goal of this investigation is to show how to create and repair different types of median nerve (MN) lesions in the rat. Moreover, different methods of simulating postoperative physiotherapy are presented. Multiple standardized strategies are used to assess motor and sensory recovery using an MN model of peripheral nerve lesion and repair, thus permitting easy comparison of the results. Several options are included for providing a postoperative physiotherapy-like environment to rats that have undergone MN injuries. Finally, the paper provides a method to evaluate the recovery of the MN using several noninvasive tests (i.e., grasping test, pin prick test, ladder rung walking test, rope climbing test, and walking track analysis), and physiological measurements (infrared thermography, electroneuromyography, flexion strength evaluation, and flexor carpi radialis muscle weight determination). Hence, this model seems particularly appropriate to replicate a clinical scenario, facilitating extrapolation of results to the human species.
Although the sciatic nerve is the most studied nerve in peripheral nerve research, analysis of the rat MN presents various advantages. For example, there is a reduced incidence of joint contractures and automutilation of the affected limb in MN lesion studies. Furthermore, the MN is not covered by muscle masses, making its dissection easier than that of the sciatic nerve. In addition, MN recovery is observed sooner, because the MN is shorter than the sciatic nerve. Also, the MN has a parallel path to the ulnar nerve in the arm. Hence, the ulnar nerve can be easily used as the nerve graft for repairing MN injuries. Finally, the MN in rats is located in the forelimb, akin to the human upper limb; in humans, the upper limb is the site of most peripheral nerve lesions.

Presented is a protocol to produce different types of median nerve (MN) lesions and repair in the rat. Additionally, the protocol shows how to evaluate the functional recovery of the nerve using several noninvasive behavioral tests and physiological measurements.

大鼠中位神经再生评价的功能与生理方法

The main goal of this investigation is to show how to create and repair different types of median nerve (MN) lesions in the rat. Moreover, different ...

Modified Spared Nerve Injury Surgery Model of Neuropathic Pain in Mice

Spared nerve injury (SNI) is an animal model that mimics the cardinal symptoms of peripheral nerve injury for studying the molecular and cellular mechanism of neuropathic pain in mice and rats. Currently, there are two types of SNI model, one to cut and ligate the common peroneal and the tibial nerves with intact sural nerve, which is defined as SNIs in this study, and another to cut and ligate the common peroneal and the sural nerves with intact tibial nerve, which is defined as SNIt in this study. Because the sural nerve is purely sensory whereas the tibial nerve contains both motor and sensory fibers, the SNIt model has much less motor deficit than the SNIs model. In the traditional SNIt mouse model, the common peroneal and the sural nerves are cut and ligated separately. Here a modified SNIt surgery method is described to damage both common peroneal and sural nerves with only one ligation and one cut with a shorter procedure time, which is easier to perform and reduces the potential risk of stretching the sciatic or tibial nerves, and produces similar mechanical hypersensitivity as the traditional SNIt model.

<meta charset="utf8"></head><body>改良的小鼠神经性疼痛备用神经损伤手术模型

The modified surgery is a simplified method for mouse or rat spared nerve injury model that requires only one ligation and one cut to injure both common peroneal and sural nerves.

改良的小鼠神经性疼痛备用神经损伤手术模型

Spared nerve injury (SNI) is an animal model that mimics the cardinal symptoms of peripheral nerve injury for studying the molecular and cellular ...

Traumatic Peripheral Nerve Injury in Mice

Traumatic peripheral nerve injury (TPNI) is a common cause of morbidity following orthopedic trauma. Reproducible and precise methods of injuring nerve and denervating muscle have long been a goal in musculoskeletal research. Many traumatically injured limbs have nerve trauma that defines the long-term patient outcome. Over several years, precise methods of producing microsurgical nerve injuries have been developed, including crush, lacerations, and nerve-gap grafting, allowing for reproducible outcome assessments. Moreover, newer methods are created for calibrated crush injuries that offer clinically relevant correlations with outcomes used to assess human patients. The principles of minimal manipulation to ensure low variability in nerve injury allow for adding still more associated tissue injuries into these models. This includes direct muscle crush and other components of limb injury. Finally, atrophy assessment and precise analysis of behavioral outcomes make these methods a complete package for studying musculoskeletal trauma that realistically incorporates all the elements of human traumatic limb injury.

The present protocol describes traumatic peripheral nerve injuries (TPNIs), including precisely calibrated crush, strictly aligned and misaligned laceration, as well as grafted and non-grafted gaps of the sciatic nerve in mice. Custom-designed sensors are developed to gauge nerve trauma, induced with commonly available tools to ensure reproducible post-TPNI outcomes.

Traumatic peripheral nerve injury (TPNI) is a common cause of morbidity following orthopedic trauma. Reproducible and precise methods of injuring nerve ...

Surgery and Behavioral Testing in the Tibial Neuroma Transposition Model in Rats

The tibial neuroma transposition (TNT) is a rat model in which allodynia at the neuroma site (tibial nerve) can be independently evaluated from allodynia at the plantar surface of the hind paw innervated by the intact sural nerve. This TNT model is suitable to test therapies for neuroma pain, such as the potential superiority of certain surgical therapies that are already used in the clinic, or to evaluate new drugs and their effect on both pain modalities in the same animal. In this model, a distal lesion (neurotmesis) is made in the tibial nerve, and the proximal nerve end is transposed and fixed subcutaneously and pretibially to enable assessments of the neuroma site with a 15 g Von Frey monofilament. To assess allodynia over the sural nerve, Von Frey monofilaments can be used via the up-down method on the plantar lateral region of the hind paw. After cutting the tibial nerve, mechanical hypersensitivity develops at the neuroma site within 1 week after surgery and persists at least until 12 weeks after surgery. Allodynia at the sural innervated plantar surface develops within 3 weeks after surgery compared to the contralateral limb. At 12 weeks, a neuroma forms on the proximal end of the severed tibial nerve, indicated by dispersion and swirling of axons. For the TNT model surgery, multiple critical (micro)surgical steps need to be followed, and some surgery practice under terminal anesthesia is advised. Compared to other neuropathic pain models, such as the spared nerve injury model, allodynia over the neuroma site can be independently tested from sural nerve hypersensitivity in the TNT model. However, the neuroma site can be tested only in rats, not in mice. The tips and directions provided in this protocol can help research groups working on pain successfully implement the TNT model in their facility.

This protocol describes the tibial neuroma transposition model, which entails a lesion of the tibial nerve with subsequent transposition of the proximal nerve end toward a subcutaneous pretibial or lateral position. Behavioral testing of neuroma pain and plantar hyperalgesia is quantified using Von Frey monofilaments.

大鼠胫神经瘤转位模型中的手术和行为测试

The tibial neuroma transposition (TNT) is a rat model in which allodynia at the neuroma site (tibial nerve) can be independently evaluated from allodynia ...

Partial Sciatic Nerve Ligation: A Mouse Model of Chronic Neuropathic Pain to Study the Antinociceptive Effect of Novel Therapies

Management of chronic pain remains challenging to this day, and current treatments are associated with adverse effects, including tolerance and addiction. Chronic neuropathic pain results from lesions or diseases in the somatosensory system. To investigate potential therapies with reduced side effects, animal pain models are the gold standard in preclinical studies. Therefore, well-characterized and well-described models are crucial for the development and validation of innovative therapies. 
Partial ligation of the sciatic nerve (pSNL) is a procedure that induces chronic neuropathic pain in mice, characterized by mechanical and thermal hypersensitivity, ongoing pain, and changes in limb temperature, making this model a great fit to study neuropathic pain preclinically. pSNL is an advantageous model to study neuropathic pain as it reproduces many symptoms observed in humans with neuropathic pain. Furthermore, the surgical procedure is relatively fast and straightforward to perform. Unilateral pSNL of one limb allows for comparison between the ipsilateral and contralateral paws, as well as evaluation of central sensitization. 
To induce chronic neuropathic hypersensitivity, a 9-0 non-absorbable nylon thread is used to ligate the dorsal third of the sciatic nerve. This article describes the surgical procedure and characterizes the development of chronic neuropathic pain through multiple commonly used behavioral tests. As a plethora of innovative therapies are now being investigated to treat chronic pain, this article provides crucial concepts for standardization and an accurate description of surgeries required to induce neuropathic pain.

Partial sciatic nerve ligation induces long-lasting chronic neuropathic pain, characterized by exaggerated responses to thermal and mechanical stimuli. This mouse model of neuropathic pain is commonly used to study innovative therapies for pain management. This article describes in detail the surgical procedure to improve standardization and reproducibility.

部分坐骨神经结扎术:慢性神经性疼痛的小鼠模型，用于研究新疗法的抗伤害感受作用

Management of chronic pain remains challenging to this day, and current treatments are associated with adverse effects, including tolerance and addiction. ...

微创拇外翻手术中神经风险的解剖学研究

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幸免神经损伤（SNI）模型引起的机械触感小鼠

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乙醇诱导的颈椎交交型神经节阻滞在促进犬下肺泡神经再生中的应用

大鼠中位神经再生评价的功能与生理方法

改良的小鼠神经性疼痛备用神经损伤手术模型

改良的小鼠神经性疼痛备用神经损伤手术模型

Traumatic Peripheral Nerve Injury in Mice

大鼠胫神经瘤转位模型中的手术和行为测试

部分坐骨神经结扎术:慢性神经性疼痛的小鼠模型，用于研究新疗法的抗伤害感受作用