사체를 이용한 이상근 주사 위치에 대한 해부학적 지표

민지혜,최은석,이원일,김고운,이베나 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.1

Objective: To identify the optimal site for piriformis muscle injection, using easily detectable sacroiliac joint as a landmark, under fluoroscopic guidance. Method: We examined the anatomic relationships of the sciatic nerve, piriformis muscle and sacroiliac joint in 18 buttocks from 9 cadavers. The distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve, and the width of the sciatic nerve at that point were measured. We assessed the depth of the piriformis muscle and the sciatic nerve using ultrasonography in asymptomatic controls. Results: The mean distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve was 15.7±3.4 (12∼22) mm laterally and 16.5±4.1 (10∼25) mm caudally. The mean width of the sciatic nerve at that point was 15.4±3.7 (12∼22) mm. Ultrasonographic findings revealed the mean distance as 4.48±0.49 cm from the skin to the surface of the piriformis muscle and as 5.68±0.62 from the skin to the surface of the sciatic nerve. Conclusion: The most optimal injection site for piriformis syndrome was located 15.6±3.4 (12∼22) mm laterally and 16.5±4.1 (10∼25) mm caudally from the inferior margin of the sacroiliac joint. Objective: To identify the optimal site for piriformis muscle injection, using easily detectable sacroiliac joint as a landmark, under fluoroscopic guidance. Method: We examined the anatomic relationships of the sciatic nerve, piriformis muscle and sacroiliac joint in 18 buttocks from 9 cadavers. The distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve, and the width of the sciatic nerve at that point were measured. We assessed the depth of the piriformis muscle and the sciatic nerve using ultrasonography in asymptomatic controls. Results: The mean distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve was 15.7±3.4 (12∼22) mm laterally and 16.5±4.1 (10∼25) mm caudally. The mean width of the sciatic nerve at that point was 15.4±3.7 (12∼22) mm. Ultrasonographic findings revealed the mean distance as 4.48±0.49 cm from the skin to the surface of the piriformis muscle and as 5.68±0.62 from the skin to the surface of the sciatic nerve. Conclusion: The most optimal injection site for piriformis syndrome was located 15.6±3.4 (12∼22) mm laterally and 16.5±4.1 (10∼25) mm caudally from the inferior margin of the sacroiliac joint.

사물제통탕(四物除痛湯)이 Taxol 처리 및 좌골신경 압좌 손상 후 신경조직 변화에 미치는 영향

윤성식,김철중,조충식,Youn, Sung-Sik,Kim, Chul-Jung,Cho, Chung-Sik 대한한방내과학회 2012 大韓韓方內科學會誌 Vol.33 No.2

Background : Peripheral nerves more rapidly recover than central nerves. However, it has been known that the degree of reaction of axons of peripheral nerves is affected by distinctive characteristics of axons and environmental factors near the axons. Taxol is a widely used medicine as for ovarian, breast, lung and gastric cancer. However it causes patients difficulties under treatment due to its toxic and side effects, which include persistent pain. Objectives : This study reviewed how SJT extract in vitro and in vivo affects nerve tissues of a sciatic nerve damaged by Taxol. It also studied how SJT extract in vivo affects axons of the sciatic nerve after the sciatic nerve was damaged by pressing. Methods : After vehicle, Taxol, and Taxol plus SJT were treated respectively for tissue of the sciatic nerve in vitro and then tissues were observed using Neurofilament 200, Hoechst, ${\beta}$-tubulin, $S100{\beta}$, caspase-3 and anti-cdc2. SJT was also oral medicated by injecting Taxol into the sciatic nerve of in vivo rats. Tissues of the sciatic nerve and axons of DRG sensory nerves were then observed using Neurofilament 200, Hoechst, ${\beta}$-tubulin, $S100{\beta}$, caspase-3 and p-Erk1/2. After inflicting pressing damage to the sciatic nerve of in vivo rats, tissues of the sciatic nerve and DRG sensory nerve were observed using Neurofilament 200, Hoechst, $S100{\beta}$, caspase-3, anti-cdc2, phospho-vimentin, ${\beta}1$-integrin, Dil reverse tracking and p-Erk1/2. Results : The group of in vitro Taxol plus SJT treatment had meaningful effects after sciatic nerve tissue was damaged by Taxol. The group of in vivo SJT treatment had effects of regenerating Schwann cells and axons which were damaged by Taxol treatment. The group of in vivo SJT had effects of regenerating axons in damaged areas after the sciatic nerve was damaged by pressing, and also had variations of distribution in Schwann cells at DRG sensory nerves and axons. Conclusions : This study confirmed that SJT treatment is effective for growth of axons in the sciatic nerve tissues and improvement of Schwann cells after axons of the sciatic nerve tissues was damaged. After tissues of sciatic nerve was damaged by pressing in vivo, SJT treatment had effects on promoting regeneration of axon in the damaged area and reactional capabilities in axons of DRG sensory nerves.

운동이 좌골신경 손상 F344쥐의 Neurotrophins, BDNF, NT-3, GAP-43 단백질 발현과 축삭재생에 미치는 영향

윤진환,서태범,Yoon Jin-Hwan,Seo Tae-Beom 한국생명과학회 2006 생명과학회지 Vol.16 No.3

본 연구에서는 흰쥐의 좌골신경을 손상시킨 후 트레드밀 운동을 적용하여 신경돌기 성장과 좌골신경의 축삭 재생 및 신경성장 인자 발현 그리고 신경기능지수의 변화를 연구했다. 본 연구결과 좌골손상 후 트레드밀 운동을 실시한 그룹이 비운동군에 비해 축삭재생이 촉진되었고, 원위부의 좌골신경에서도 NGF, BDNF단백질 발현이 상당히 증가된 것으로 나타났다. 또한 좌골신경지수를 검사한 결과에서도 운동을 실시한 흰쥐가 비운동 흰쥐에 비해 기능적 회복이 상당히 빠른 것으로 나타났다. 이러한 결과는 좌골손상 후 운동의 실시가 좌골신경의 축삭재생 촉진과 신경영양인자의 발현증가를 통해 기능적 회복에 도움이 될 수 있음을 보여주는 것이다. Peripheral nerve injuries are a commonly encountered clinical problem and often result in severe functional deficits. In the present study, the effects of treadmill exercise on neurotrophin expressions and functional recovery following sciatic crushed nerve injury were investigated. Animals were randomly assigned into four groups: the sciatic nerve injury group, the sciatic nerve injury and 3-day-exercise, the sciatic nerve injury and 7-days-exercise, and the sciatic nerve injury and 14-days-exercise groups. Sciatic nerve injury was caused by crushing the right sciatic nerve for 30 s using a surgical clip. A the light-exercise was applied to each of the exercise group over the respective number of days. In the present results, we identified enhanced axonal re-growth in the distal stump of the sciatic nerve 3-14 days after crush injury with treadmill training. Dorsal root ganglion (DRG) neuron when cultured from animals with nerve injury and treadmill training showed more enhanced neurite outgrowth than that of sedentary animals. Nerve growth factor (NGF) protein levels in low-intensity treadmill training group were highly induced in the injured sciatic nerves 3, 7 and 14 days after injury compared with sedentary group, and brain-derived neurotrophin factor (BDNF) protein levels in treadmill exercise group were highly induced in the injured sciatic nerve 3 days after injury compared with sedentary group. Then, treadmill exercise increased neurotrophic factors induced in the regenerating nerves. We further demonstrate that motor functional recovery after sciatic nerve injury was promoted by treadmill exercise. Thus, the present data provide a new evidence that treadmill exercise enhanced neurotrophins expression and axonal regeneration after sciatic nerve injury in rats.

화타협척혈 침자극에 의한 손상 말초신경의 재생효과에 관한 연구

김대필 ( Dae Feel Kim ),박영회 ( Young Hoi Park ),금동호 ( Dong Ho Keum ) 한방재활의학과학회 2008 한방재활의학과학회지 Vol.18 No.4

목 적 : 좌골신경 압좌손상으로 유발된 쥐의 모델을 이용하여 손상된 말초신경의 재생효과에 관한 침자극 효과를 세포분자학적, 조직학적 관점에서 연구하였다. 아울러 손상 좌골신경을 지배하는 척수신경근과 가까운 부위 경혈자극과 좌골신경이 지배하는 말초부위 경혈자극과의 침자극 효과를 비교 연구하였다. 방 법 : 한쪽 좌골신경에 압좌손상을 유발 한 실험쥐들을 1주, 2주로 나눈 뒤 각각에 대해 격일로 1주군은 3회, 2주군은 6회의 침자극을 시행하였다. 손상 좌골신경의 재생효과를 비교실험하기 위해 정상군, 압좌손상만을 유발한 실험군, 침자극 군으로 나누었다. 침자극 군 중 한 군은 손상신경을 지배하는 척수신경근에 가장 가까운 2개의 화타협척혈(EX B2)에 자침(근위부 자극군)하였고, 다른 한 군은 말초부위에 위치한 족삼리혈(ST 36)과 위중혈(BL 40) 2곳에 자침(원위부 자극군)하였다. 실험 후 각각의 조직을 분리하여 Western blotting 혹은 Hoechst staining으로 Gap-43, Cdc2, Cdk2, Erk1/2 단백질을 분석 및 좌골신경의 각 세포수를 측정하였다. Retrograde tracing을 통해 L5의 DRG와 척수에서 말초신경 재생 효과를 관찰하였고, Immunofluorescence staining을 통해 신경돌기 가지의 신장 정도를 파악하였다. 결 과 : 좌골신경 손상 7일된 실험쥐의 근위부와 원위부 침자극군에서 GAP-43와 Cdc2 단백질수준이 향상된 것으로 나타났다. Cdk2 단백질수준은 압좌손상 실험군에서 강하게 증가하였지만 침자극군과 비교해서 별다른 차이는 보이지 않았다. Phospho-Erk1/2 단백질수준은 침자극군에서 향상된 것으로 나타났다. 손상 7일과 14일 된 실험쥐의 손상 원위부에서 슈반세포 수가 증가하였으며 특히 근위부 침자극군에서 더욱 증가한 것으로 나타났다. Retrograde tracing을 이용한 검사 결과 침자극군에서 L5의 DRG와 척수의 염색 세포 수가 증가된 것으로 나타나 침자극이 축삭재생에 효과적인 것으로 나타났다. L5의 DRG 감각신경의 신경돌기 가지 신장정도 및 GAP-43 단백질의 발현 정도를 측정한 결과 근위부 침자극군에서 효과적으로 GAP-43 단백질의 발현 및 신경돌기 가지가 신장된 것으로 나타났다. 결 론 : 본 실험결과 침치료가 손상 좌골신경의 재생에 효과적인 것으로 보여지며, 특히 손상된 좌골신경을 지배하는 척수신경근 주위 화타협척혈에 대한 침자극이 말초부위의 침자극에 비해 신경재생에 더욱 효과적인 것으로 나타났다. Objectives : The present study was performed to investigate whether acupuncture stimulation in the rats affected regeneration properties of the injured sciatic nerve. A differential effect of acupuncture stimulation on the one point near the spinal nerve root controlling sciatic nerve activity and the other point in the peripheral area subordinated by injured nerve was compared. Materials and Methods : Rat sciatic nerves were injured by crush, and the effects on axonal regeneration on injured sciatic nerves were evaluated by acupuncture stimulation at two different regions. In proximal acupuncture stimulation group, acupuncture stimulation was performed on Huatuo Jiaji(EX B2) points located from L5 to S1 vertebral levels to stimulate the nearest spinal nerve root that innervates sciatic nerves. In distal acupuncture stimulation group, acupuncture stimulation was performed on Zusanli(ST 36) and Weizhong(BL 40) points to stimulate at peripheral area dominated by injured sciatic nerves. Acupuncture stimulation was given every other days for 1 or 2 weeks. Sciatic nerve tissues collected from acupuncture stimulation experimental groups, injury control group, and intact animal group were used for protein analysis by Western blotting or Hoechst nuclear staining. To determine axonal regeneration, DiI fluorescence dye was injected into the sciatic nerve 0.5 cm distal to the injury site in individual animal groups and DiI-labeled cells by retrograde tracing were measured in the DRG at lumbar 5 or in the spinal cord. DRG sensory neurons prepared from individual animal groups were used to measure the extent of neurite outgrowth and for immunofluorescence staining with anti-GAP-43 antibody. Results : Animal groups given proximal or distal acupuncture stimulation showed upregulation of GAP-43 and Cdc2 protein levels in the sciatic nerve at 7 days after injury. Cdk2 protein levels were strongly induced by nerve injury, but did not show changes by acupuncture stimulation. Phospho-Erk1/2 protein levels were elevated by acupuncture stimulation above those present in the injury control animals. These increases in regeneration-associated protein levels appeared to be related with increased cell proliferation in the injured sciatic nerves. Hoechst 33258 staining of sciatic nerve tissue to visualize nuclei of individual cells showed increased Schwann cell number in the distal portion of the injured nerve 7 and 14 days after injury and further increases by acupuncture stimulation particularly at the proximal position. Measurement of axonal regeneration by retrograde tracing showed significantly increased DiI-labeled cells in proximal acupuncture stimulation group compared to distal acupuncture stimulation group and injury control group. Finally, an evaluation of axonal regeneration by retrograde tracing showed increased number of DiI labeled cells in the DRG at lumbar 5 or in the ventral horn of the spinal cord at lower thoracic level at 7 days after nerve injury. Conclusions : The present data show that the proximal acupuncture stimulation at Huatuo Jiaji(EX B2) points governing injured sciatic nerves was more effective for axonal regeneration than the distal acupuncture stimulation. Further studies on functional recovery or associated molecular mechanisms should be critical for developing animal models and clinical applications.

Effects of Bee Venom and Sweet Bee Venom Acupuncture on Functional Recovery and c-Fos Expression in the Brain after Sciatic Crushed Nerve Injury in Rats

Choi, Seung-Peom,Song, Yun-Kyung,Lim, Hyung-Ho The Society of Korean Medicine 2010 대한한의학회지 Vol.31 No.3

Background: Peripheral nerve injuries are commonly encountered clinical problems and often result in severe functional deficit. Bee venom acupuncture has traditionally been used to treat several inflammatory diseases and chronic pain conditions. Objectives: The aims of this study were to compare the effects of bee venom (general bee venom, BV) and sweet bee venom (allergen-removed bee venom, SBV) acupuncture on the recovery rate of locomotor function, the expression of brain-derived neurotrophic factor (BDNF) in the sciatic nerve, and the expression of c-Fos in the brain following sciatic crushed nerve injury in rats, and to evaluate differences due to administration areas. Method: Walking track analysis, Western blot for BDNF and tyrosine receptor kinase B (TrkB), and immunohistochemistry for c-Fos were performed. In this study, comparative analyses of the effects of BV and SBV acupuncture in relation to administration sites, contralateral side or ipsilateral side, were conducted. Results: In the present result, sciatic function index (SFI) in walking track analysis significantly decreased following sciatic crushed nerve injury. The expressions of BDNF and TrkB in the sciatic nerve increased after induction of sciatic crushed nerve injury. C-Fos expression in the ventrolateral periaqueductal gray (vlPAG) and paraventricular nucleus (PVN) also increased. BV and SBV acupuncture treatment improved the SFI in walking track analysis. Treatment with SBV at 1mg/kg showed more potent enhancing effect on SFI compared to BV. Treatment with 1mg/kg BV or 1mg/kg SBV acupuncture suppressed the BDNF and TrkB expression in the sciatic nerve. BV and SBV acupuncture treatment also suppressed c-Fos expression in the PVN and vlPAG regions. Treatment with SBV at 1mg/kg showed more potent suppressing effect on c-Fos expression compared to BV when injected into the contralateral side of the injured nerve. Generally we could not find significant difference in the effects between contralateral side and ipsilateral side of the injured nerve. Conclusion: We have shown that BV and SBV acupuncture treatment can be used as the effective therapeutic modality to ameliorate the symptoms of sciatic crushed nerve injury.

Effects of Bee Venom and Sweet Bee Venom Acupuncture on Functional Recovery and c-Fos Expression in the Brain after Sciatic Crushed Nerve Injury in Rats

Seung-Peom Choi,Yun-Kyung Song,Hyung-Ho Lim 대한한의학회 2010 대한한의학회지 Vol.31 No.3

흰쥐의 좌골신경 절단후 신경과 뒷다리근육에서 MCP-1 mRNA의 발현

송정훈,나영천,최명애,김민선,박병림 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.5

Migration of inflammatory cells into damaged tissue is essential to host defense mechanisms and immune responses. Monocyte chemoattractant protein-1(MCP-1), a member of the CC or β-chemokine family is a powerful leukocyte recruitment factor that is relatively specific for monocyte/macrophage. The purpose of present study was to evaluate temporal change of expression of mRNA for MCP-1 in the sciatic nerve and hindlimb muscle of Sprague-Dawley rat. The mid-portion of the sciatic nerve was exposed, cut under aseptic condition and then animals were sacrificed 1, 2, 3, 7, 14 days after denervation of the sciatic nerve. Semiquantitative RT-PCR method and image analysis system were used to analyze change in expression of mRNA for MCP-1. Expression of mRNA for MCP-1 in the distal stump of the denervated sciatic nerve was up-regulated within 1 day and peaked on the second day following transection of the sciatic nerve. Thereafter high expression of mRNA for MCP-1 lasted for 7 days after transection of the nerve. However the expression of mRNA for MCP-1 was rapidly decreased on the 14th day after denervation. Temporal change of expression of mRNA for MCP-1 in the proximal portion of the denervated sciatic nerve was very similar with that of distal one. The gastrocnemius muscle also showed significant increase in expression of mRNA for MCP-1 on the 1st day with maximal expression on the 7th day after denervation of the sciatic nerve. In contrast, the expression of mRNA for MCP-1 in the soleus muscle was lower than the gastrocnemius muscle in the course of the denervation-induced atrophy. Additionally α-lipoic acid, a potent antioxidant that is used in treatment for diabetic neuropathy, suppressed significantly expression of mRNA for MCP-1 in the denervated sciatic nerve but not in atrophied hindlimb muscles.

Dexmedetomidine Improves Locomotor Function and Alleviates Thermal Hyperalgesia Following Sciatic Nerve Crush Injury in Rats

장명수,한진희,김동옥,우길,권재익,정준영,이봉재,이재우 대한배뇨장애요실금학회 2020 International Neurourology Journal Vol.24 No.S1

Purpose: The effects of dexmedetomidine on locomotor function and thermal hyperalgesia in sciatic nerve crush injury (SNCI) were investigated using rats.Methods: After exposing the right sciatic nerve, the sciatic nerve was crushed for 1 minute by a surgical clip. One day after nerve injury, dexmedetomidine (5, 25, and 50 µg/kg) was directly applied to the injured sciatic nerve once a day for 14 days. Walking track analysis was used to assess locomotor function and plantar test was conducted to assess thermal pain sensitivity. Immunohistochemistry was performed to determine the expression of c-Fos in the ventrolateral periaqueductal gray (vlPAG) and paraventricular nucleus (PVN). Western blot was used to evaluate the expression level of nerve growth factor (NGF) and myelin basic protein (MBP) in the sciatic nerve.Results: SNCI resulted in deterioration of locomotor function and increased thermal pain sensitivity. The level of c-Fos expression in the PVN and vlPAG was increased and the level of NGF and MBP expression in the sciatic nerve was enhanced by SNCI. Dexmedetomidine treatment improved locomotor function and upregulated expression of NGF and MBP in the sciatic nerve of SNCI. Dexmedetomidine treatment alleviated thermal hyperalgesia and downregulated expression of c-Fos in the vlPAG and PVN after SNCI.Conclusions: Dexmedetomidine may be used as a potential new treatment drug for recovery of locomotion and control of pain in peripheral nerve injury.

흰쥐 좌골신경 압좌 손상 후 오약순기산 및 전침이 신경손상의 회복에 미치는 영향

양미성 ( Mi Sung Yang ),신미숙 ( Mi Suk Shin ),안혜림 ( Hye Lim An ) 한방재활의학과학회 2008 한방재활의학과학회지 Vol.18 No.4

Objectives : Ohyaksungi-san(Wuyaoshunqi-san) has been used for many years as a treatment for sciatica in oriental medicine. And electrical acupuncture also has been used as a treatment for sciatica in recent study. By the way, it is hard to find the study that apply two treatments in the same time. This study was designed to evaluate the effects of Ohyaksungi-san(Wuyaoshunqi-san) and electrical acupuncture on nerve regeneration after crush injury in rat sciatic nerve in the same time. Methods : This study was designed with 4 subgroups to evaluate the effects of Ohyaksungi-san(Wuyaoshunqi-san) and electrical acupuncture on nerve regeneration. As control groups, group Ⅰ has not been treated during 3 weeks after crush injury in rat sciatic nerve. Group Ⅱ has been treated Ohyaksungi-san(Wuyaoshunqi-san), Group Ⅲ has been treated electrical acupuncture, and Group Ⅳ has been treated both during 3 weeks. This study has been estimated sciatic function index and change of GAP-43 immunoreactivity about sciatic nerve regeneration. Results : 1. The test for nerve regeneration had significantly good result of sciatic function index in the experimental groups as compared with control groups(p<.05). Especially, Group Ⅳ has the greatest result of sciatic function index. 2. GAP-43, the marker of nerve regeneration, more increased in the experimental groups as compared with control groups. Especially, Group Ⅳ has the greatest result of GAP-43. Conclusions : Ohyaksungi-san(Wuyaoshunqi-san) and electrical acupuncture have good effects on nerve regeneration after crush injury in rat sciatic nerve.

Comparison of the Effects of Electroacupuncture and Melatonin on Nerve Regeneration in Experimentally Nerve-Damaged Rats

Yasemin Özkan,Mehmet Turgut,Yasemin Turan,Mehmet Dinçer Bilgin,Sinem Sari,Mustafa Yilmaz,Yiğit Uyanikgil,Mahmut Alp Kiliç,Derya Tanriöver,Zehra Seznur Kasar 사단법인약침학회 2021 Journal of Acupuncture & Meridian Studies Vol.14 No.5

Background: Development of methods to accelerate nerve regeneration in peripheral nerve damage is important. Electroacupuncture is a new therapeutic method that combines traditional acupuncture with modern electrotherapy. Melatonin has been shown to reduce nerve damage. Objectives: In this study, we aimed to determine and compare the therapeutic effects of electroacupuncture and melatonin on rat sciatic nerve injury. Methods: A total of 56 adult male Wistar Albino rats were divided into four study groups with 14 animals in each group: intact control (group I), subcutaneous saline (group II), subcutaneous melatonin (group III), and electroacupuncture (group IV). Surgical procedure including unilateral (right) sciatic nerve injury was applied to groups II, III, and IV. Saline and melatonin started immediately after surgery for six weeks, while electroacupuncture was given two weeks after surgery for 3 weeks. Functional and histological assessments were used as outcome measurements. Results: Sciatic nerve damage caused a significant decrease in nerve conduction velocity. Both electroacupuncture treatment and melatonin treatment significantly increased the nerve conduction velocity. Both sciatic functional recovery and histological regeneration were faster in these treatment groups compared to the saline. However, no significant difference was observed between the two treatment groups. Conclusion: Electroacupuncture and melatonin are promising alternative treatment strategies for peripheral nerve damage and can be examined in detail in future studies.