射频皱缩刀在不同工作模式下对腋神经表面温度的影响

Effect of radiofrequency capsulorrhaphy on the temperatures of the axillary nerve under different working modes

目的:观察肩关节镜下射频皱缩刀对腋神经表面温度的影响。方法:实验于2005-03/06在南京医科大学附属南京第一医院骨科实验室进行。取10个新鲜肩关节标本(南京中医药大学提供),分为肩关节持续冲洗和间断冲洗两组,模拟肩关节不稳定进行射频皱缩刀关节囊皱缩术。射频皱缩刀应用持续工作和间断工作两种不同的工作模式和1和2档能量设置,采用电动测温仪分别记录射频皱缩刀工作10,25,40,55,70s及停止工作30s时腋神经表面的温度。结果:①肩关节间断冲洗组:射频皱缩刀持续工作模式下,各个时间段腋神经表面温度升高较快,2min以后均超过70℃,最高达到85℃(3min时),停止工作30s,仍为82.3℃;射频皱缩刀间断工作模式下腋神经表面温度较持续工作模式升高慢(P<0.01),各个时间点均不超过60℃,最高才达到58℃(70s时)。②肩关节持续冲洗组:射频皱缩刀持续工作模式下,皱缩能量为1档和2档时,在30s时腋神经表面的温度不差异(P>0.05),而连续工作1min以上,能量为1档时,各个时间点所测温度均比能量为2档时低(P<0.05);射频皱缩刀间断工作模式下,皱缩能量为1档和2档时,在10,25s时,腋神经表面温度差异不显著(P>0.05),40s后,能量为1档时,腋神经表面温度比能量为2档时低(P<0.05)。在肩关节持续冲洗和能量为1档时,射频皱缩刀在两种工作模式下,腋神经表面温度均不超过50℃。结论:在肩关节镜下行射频皱缩术时,腋神经表面温度会明显升高,持续冲洗、间断工作模式可降低腋神经表面温度;而间断冲洗、持续工作模式可能会损伤腋神经。

AIM： To explore the influence of radiofrequency （RF） capsulorrhaphy on the temperatures of axUlary nerve under shoulder arthroscopy. METHODS： From March to June 2005 the experiment was conducted at the Orthopaedic Laboratory of Nanjing First Hospital Affiliated to Nanjing Medical University. Ten fresh shoulder samples were collected from Nanjing University of Traditional Chinese Medicine and randomly assigned into continuous irrigation group and intermittent irrigation group, and then received RF capsulorrhaphy after modeling unstable shoulder joint. The shoulders were undergone continuous and intermittent modes and energy step one and step two. The temperatures of axillary nerve were recorded at working 10, 25, 40, 55 and 70 s and stopping working 30 s with automatic temperature measurement gauge. RESULTS： ①In the intermittent irrigation group, the temperatures of axUlary nerve were increased rapidly under continuous RF capsulorrhaphy, and exceeded 70 % 2 minutes later, and reached the peak 85 % at minute 3, and still 82.3 % when stopping working for 30 s. The temperatures of axUlary nerve were increased slowly under intermittent RF capsulorrhaphy （P〈 0.01）, and did not exceed 60 ~C at every time point, and the highest 58 % at 70 s. ②In the continuous irrigation group, the temperatures were not different between energy step one and step two under continuous RF capsulorrhaphy at 30 s （P 〉 0.05）. However, the temperature at every time points was lower at energy step one than at energy step two for over 1 minute successive working （P 〈 0.05）. No significant difference was found in temperatures of axUlary nerve between energy step one and step two under intermittent RF capsulorrhaphy at 10 and 25 s （P〉 0.05）. 40 s later, temperatures of axUlary nerve were lower at energy step one than at energy step two （P〈 0.05）. The temperatures of axUlary nerve did not exceed 50 % in the continuous irrigation group under two kinds of modes at energy step one. CONCLUSION： The temperature of the axillary nerve can significantly increase in arthroscopically RF capsulorrhaphy. Continuous irrigation as well as intermittent RF treatment can decrease the temperature, whereas intermittent irrigation in combination with continuous RF treatment can damage the axUlary nerve.