ϟΕਔ໔ᗺᆶઓ࿶ӆғϐЎ᝘ӣ៝ - 中國醫藥大學機構典藏 China Medical University Repository, Taiwan:Item 310903500/32403

Kozolowski ฻^[196] , 1996ǹHumm ฻^[197], 1998ǹDeBow ฻^[198],2008ࣴ زύᡉҢǴόፕࢂӧᖏ׉܈ࢂ୏ނჴᡍБय़ǴՖਔࢂന࡞྽ޑൺ଼ݯᕍ ϟΕਔᐒࣣۘ҂ܴਟǴёૈᆶڙཞރݩԖᜢǶԶ Alaverdashvili ฻^[199], 2008 ᇡࣁό፾྽ޑൺ଼ำׇҭёૈቹៜႣࡕǴٯӵᏢ཮όؼ٬ҔǶӧ Griesbach ฻^[200],2007 ޑჴᡍύගрઓ࿶ڙཞࡕٿࢃයӆ๏ϒ૽ግݯᕍ Кҥջ๏ϒݯᕍ׳ૈቚу BDNF ޑ߄౜Ϸߦ຾фૈࡠൺǴჴᡍว౜ೌࡕ 7-14 Ϻӆ๏ϒ૽ግಔޑ BDNF ቚуໆ࣬ၨܭೌࡕҥջ๏ϒ૽ግ 6 Ϻಔ ଯǶԶа FPI εႵࣁჴᡍኳԄύǴว౜ԾЬ܄ൺ଼ݯᕍޑԋਏ཮Ӣڙཞ ำࡋԶ౦Ǵӧᇸࡋ FPI εႵࡼϒҥջາ፺૽ግ٠ό཮٬ၮ୏Їวޑ BDNF ቚуǴϸԶࢂӧೌࡕ 14-20 Ϻࡼϒາ፺૽ግǴੇଭ଑ޑ BDNF ཮ ᒿၮ୏ໆቚуԶԋКٯቚуǴεႵ FPI ҥջ๏ϒາ፺૽ግ٠ό཮٬

BDNF ቚуǴೌࡕ 0-6 Ϻ๏ϒ૽ግϸԶ཮Ꮴठ CREB ک synapsio̹ޑΠ फ़Ǵύࡋ FPI εႵӧ PID30-36 Ϻ๏ϒາ፺ၮ୏ݯᕍǴځ BDNFǵCREB ک synapsio̹֡཮΢ϲǶHumm ฻^[197],(1998)ǹRisedal ฻^[201],(1999)ǹDeBow

฻^[198],(2008)ჴᡍࣣගϷၸԐ๏ϒݯᕍϸԶ཮ቚуઓ࿶ڙཞำࡋǶӧ

Schwartz & Yoles,^[202] (2006)ǹBenowitz & Yin,^[203] (2008)ǹChen^[204]฻ (2008)ჴᡍύࣣගډӧ SCI ࡕǴϷԐ๏ϒൺ଼ᙖҗཞ໾Їวޑ೷ࠠ܄ک ࢲϯխࣝس಍ٰуೲൺচǴԶӧ Jones ฻^[205],(1999)ޑჴᡍ߾ፕϷջԐ๏

ϒൺ଼ёගଯઓ࿶ᖿϯӢηǶGirgis^[206] (2007)ჴᡍύว౜ҥջ๏ϒݯᕍ ёૈ཮Ԗॄय़ቹៜǴᏤठࢌ٤੝܄фૈޑࡠൺڙߔǴӧೌࡕ 4 Ϻӆ๏ϒ ൺ଼ݯᕍૈᡉ๱ගଯ૽ግԋ݀Ƕӧ Krajacic A.^[207] ฻,(2009)аόֹӄૉ

ᡎཞ໾εႵࣁჴᡍኳԄǴӧೌࡕ 12 Ϻӆ๏ϒൺ଼૽ግǴ؂ВΜϩដǴ

΋ຼϤϺǴ࡭ុϤຼǴว౜ۯࡕ๏ϒ૽ግ٠όቹៜҜ፦კႽׯᡂǴԶڙ ၸ૽ግϐεႵځҜ፦ཞ໾ำࡋၨλǶHumm JL ฻^[197],(1998)ޑჴᡍаൂ

ୁεတڙཞεႵࣁჴᡍኳԄǴஒ҅தୁ߻ަڰۓǴ٬εႵၸࡋ٬ҔѨҔ

ޑ஻ୁ߻ަǴว౜ऩၸࡋ٬Ҕ஻ަޑރݩวғӧೌࡕ 7 ϺϣǴ߾཮Ꮴठ ઓ࿶ཞ໾ቚуǴ٠ቹៜځфૈࡠൺǴӵ݀วғӧೌࡕಃΒຼǴ߾ό཮Ꮴ ठઓ࿶ཞ໾уቃǴՠϝ཮ቹៜфૈࡠൺǶ

ךॺҗЎ᝘ޑ௖૸ளޕǴႝଞ೏ቶݱޑࣴزς࿶Ԗ΋ࢤߏᇻޑᐕ ำǴԾԐයಔᙃ୻Ꭶύளޕႝ൑ёа،ۓઓ࿶ᔼᎦނ፦ޑБӛ຾΋؁ߦ

຾ځӆғǴᅌᅌ࿶җ୏ނჴᡍளډΑ᛾ჴ྽ႝཱུޑՏ࿼όӕǵᓎ౗ޑό ӕǵ୏ނࠔᅿޑόӕǵமࡋޑόӕǵᒧҔޑઓ࿶όӕǵڈᐟޑՏ࿼όӕǵ ᄒᘐߏࡋόӕǵཞ໾ኳԄόӕ฻೿཮ቹៜઓ࿶ӆғޑ่݀ǴԶЪ܌ளډ ޑ่݀ΨԖٿཱུޑৡ౦܄௢ፕǴՠεܢᒥൻ΋ঁচ߾྽഍ཱུܫ࿼ᇻᆄ܈

ࢂեᓎႝڈᐟ཮Ԗߦ຾ޑਏ݀ǹԶ໚ཱུܫ࿼ᇻᆄ܈ࢂଯᓎႝڈᐟ߾Ԗ׭

ڋޑਏ݀Ƕ຾΋؁ԖᏢޣᄌᄌѐࣴزځᐒڋගрΑёૈၟ້ᚆη೯ၰǵ

໊/ႇᚆη೯ၰ܈ࢂ΋٤ઓ࿶ғߏӢη(ӵBDNF)ޑፓ௓࣬ᜢǴ౜ςᅌԋ ᚉ׎ǶฅԶǴёெޑࢂӭኧޑࣴز೿ࢂ٬Ҕൂ΋ႝࢬமࡋ܈ᓎ౗܈ࢂၨ

อޑᄒᘐຯᚆǴ٠҂ଞჹၨߏຯᚆޑᄒᘐຯᚆ܈ࢂ๏ᆶόӕೱុᓎ౗ޑ ڈᐟٰуаᢀჸࣴزǶٯӵǺCheng฻^[177](2004)ว߄ճҔόӕᓎ౗Ϸம ࡋႝଞڈᐟᄒᘐεႵ֤ମઓ࿶଺௖૸Ǵว౜ᓎ౗ຫଯઓ࿶ᠼᆢᡂޑಒλ ЪՈᆅஏࡋቚуǶՠࢂдॺ܌٬Ҕޑ೭΋ጇ௦Ҕ7 mmޑઓ࿶໔ຯǴਥᏵ Yannas^[81]ޑࣴزઓ࿶ӆғௗӝ౗ࣁ50%ޑઓ࿶໔ሜǴεႵޑғߏനεຯ ᚆ9.7 ± 1.8 mmǴ܌а7 mmჴሞ΢೭ҁٰ൩ࢂઓ࿶ёаߏၸѐޑຯᚆǴ ӆޣځܫ࿼ႝཱུޑՏ࿼όӧᄒᘐઓ࿶ޑٿୁԶ೿ᒧ᏷ӧᘐᆄᇻୁᆶ΋

૓ޑ٬Ҕচ߾όϼ࣬಄ǴЪຑ՗Бݤ໻௦ҔಔᙃϪТǴךॺҗკ׎ٰ࣮

٠όڀԖж߄܄Ǵ܌аຑ՗Бݤ҂ڀӄय़܄Ǵӕਔ҂ჹઓ࿶ޑԋф౗຾

ՉᇥܴǶќѦ׵฻^[182] (2005)ࣴزύᢀჸډόӕᓎ౗ႝଞჹӆғၸำύઓ

࿶ಔᙃ׎ᄊᏢаϷѨઓ࿶Ѝଛޑ๢ဉԼԼಒझ׎ᄊीໆᏢޑቹៜǴՠࢂ

܌௦ڗޑຯᚆΨၸλ٠όڀԖж߄܄Ƕ܌аҁჴᡍЬा௖૸࣬ӕႝଞڈ ᐟόӕϟΕਔ໔ᗺჹߏຯᚆεႵᄒᘐ֤ମઓ࿶ޑቹៜǴЪଛӝӧ੝ۓ߲

Ҥ΢уаڈᐟǴЬाࢂӢࣁύᙴ໺಍ᙴᏢϷଞءᗨฅؒԖ҅Ԅޑගډ࣬

ᘐઓ࿶ᘐ໾ޑݯᕍǴՠவ΋٤ђᝤޑࣴزύёᑍـ೽ҽᆄইǴ຾Զམଛ ݯᕍаᙖԜߦ຾ઓ࿶ޑӆғǶ

2.4 ઓ࿶ཞ໾ޑύᙴᢀᗺ

2.4.1 ઓ࿶س಍ӧύᙴᏢύޑۓՏ

ύᙴᗨؒԖઓ࿶೭ঁ஑ԖӜຒǴՠаύᙴᏢޑفࡋϷђڂϐ૶ၩǴ ଛӝ౜жᙴᏢϐඔॊǴϝԖᇥܴઓ࿶ޑཷۺǶ

ύኰઓ࿶س಍Бय़ǴȠ໳ࡆϣ࿶ȡςԖတᆶᡎޑӜᆀǴΒޣឦڻࡡ ϐ۬Ǵᆶٿޣ࣬ᜢᖄޑ࿶๎Ԗ࿎ેǵ๝࿶ǵط࿶ǵᆮા࿶฻Ƕՠࢂڬᜐ ઓ࿶ύᙴڂᝤค҅Ԅઓ࿶ӜຒϐЎ᝘೏ගϷǴђΓࡽฅ૶ၩ“ࡋໆϪ ൻǴှওຎϐ”ϐှওᏢϐᔈҔǴ౛ፕ΢ᔈஒӵӕՈᆅޑڬᜐઓ࿶όठ

೏۹ౣǶࡽฅӵԜǴٗڬᜐઓ࿶ǴᔈаՖᅿፕॊٰև౜ǻ௢ፕԶقǴᔈ ᆶ࿶๎Ꮲᇥޑёૈ܄നଯǶ

࿶๎

࿶๎ޑჴ፦ࢂϙሶǴԿϞϝࢂঁᖮǶՠࢂவЎ᝘Ϸᖏ׉ࣴز΢ᡉ ҢǴ࿶๎ᆶઓ࿶ԖஏϪᜢ߯Ƕ܈ޣᔈ၀ᇥ࿶๎ޑཷۺύх֖Αઓ࿶س

಍Ƕӧഋϼᑢ௲௤ȨҤᐋȩ౛ፕύҭගϷ࿶๎ޑཷۺύ఼ᇂΑઓ࿶س಍

ޑཷۺǶȬનୢΘҁᙒȭǺȨ࿶ેޣǴ܌аՉՈ਻Զᄪ഍໚ǴᔶโମǴճ ᜢ࿯ޣΨȩǵȨϻٕ࠼ε๎ޣǴѰݙѓǴѓݙѰǴ΢ΠѰѓᆶ࿶࣬υǴԶ ѲܭѤ҃Ǵځ਻คதೀǴόΕܭ࿶߲ȩǵȬᡫኰΘੇፕȭǺȨϻΜΒ࿶ેޣǴ ϣឦܭ᠌๜ǴѦ๎ܭަ࿯ȩ^[208]Ԝ࿶๎ޑཷۺ҅ک఼ᇂΑڬൎઓ࿶ޑϩѲ ᆶфૈǶȬનୢȭǺќѦǴȨፏેࣣ೯Ϊတȩޑཷۺӧ΋ۓޑำࡋ΢ҭϸ

ࢀΑڬൎઓ࿶ᆶύኰઓ࿶ޑᖄᛠᜢ߯Ƕ஭฻^[209-211]ࣴزύΨගډ࿶๎س

಍่ᄬ΢ޑᐱ੝܄ࣁ࿶๎ᆶᐒᡏޑઓ࿶ǵՈᆅǵరЃᆅ֡ԖஏϪޑᖄ ᛠǴՠΨӸӧ΋ۓৡ౦Ƕԙ฻^[212]ࣴزύΨගډ“࿶๎”ٿӷޑӷྍᏢ֖က ΨڀԖઓ࿶سфૈǶӧܴ҃໺ΕޑՋБှওғ౛ᏢǴ܈ࢂӧఁమՋБᙴ ᏢࣽᏢޑܿ໺ၸำύǴᆶ࿶๎фૈ࣬ᜢޑύᙴᜏ༼ӵ“ಒโ”ǵ“س”฻ම բࣁ“nerve”ޑᅇ᝿ӜຒǴவԶӧύՋᙴ༊೯ޑ߃ബ໘ࢤǴ൚ۓΑ࿶๎ᆶ ઓ࿶фૈࢲ୏࣬ᜢޑЎӷᙯඤ୷ᘵǶ׵฻^[213]ࣴزύΨගрၨֹ๓ޑ࿶๎

س಍ࢂઓ࿶س಍ଯࡋ຾ϯࡕр౜ޑ(வԶёа೯ၸ࿶๎ፓ࿯ઓ࿶س಍)Ǵ Զཀ᛽ઓ࿶س಍ΨࢂԾฅࣚ຾ϯޑനଯౢނǴΞࢂࡌҥӧઓ࿶ک࿶๎ٿ ޣϐ΢ޑ(೯ၸཀ᛽ёаፓ࿯࿶๎Ǵ຾Զፓ࿯ӄي) Ƕ܌аךॺёаளޕ

࿶๎ၟઓ࿶س಍ΜϩஏϪΨࢂҞ߻ࣴزനӭКၨௗ߈ޑБӛǶ

߈жᏢޣჹ࿶ેᆶڬൎઓ࿶ޑᜢᖄ܄ǴբΑ׳၁ಒޑඔॊǶቅМ

[214]

Ǻ࿶ેుӧᡏϣǴрΕܭ᠌๜โମԼԺϐ໔ǴၹѲܭӄي΢ΠǴᓐय़ ѤަǶԶഋМ^[215]׳٩Ᏽ΢ΠަΜΒ࿶ે੝ۓޑϩѲБՏǴஒځҜΠӸӧ ޑՈᆅᆶઓ࿶״ᛤᇙԋკ᛼Ǵ٠Ҕ౜жှওᏢᇥܴځჴ፦ǶಷМ^[216]Ǻύ ᙴ܌ࡰϐတᡎࣁϞϐύኰઓ࿶س಍Ǵхࡴεတǵ໔တǵύတǵλတǵۯ ᡎϷૉᡎ฻ǹ࿶ેǴջϞϐڬൎൻᕉس಍Ϸઓ࿶س಍ǶӢԜǴڬൎઓ࿶

ёຎࣁ࿶ેޑ΋೽ϩǴрΕܭ᠌๜โମԼԺϐ໔ǴၹѲܭӄي΢Πᆶᓐ य़ѤަǶ

аΜΒ࿶ેϐൻՉǴΜΒ࿶ેϐғ౛Ǵคݤԭϩϐԭᆶ౜ӧϐڬᜐ ઓ࿶س಍ֹӄࠨӝǴՠύᙴޑ᏾ᡏࡘᆢ่ᄬ఼ᇂՋᙴϐઓ࿶ှওфૈࢂ

όݾޑ٣ჴǶ

2.4.2 ڬᜐઓ࿶ᘐ໾ᆶ࣬ᜢϐύᙴੰ᛾

җܭύᙴᢀᗺ΢ǴؒԖઓ࿶ϐፕॊǴڬᜐઓ࿶ڙ໾ϐጄൎཷࡴܭѦ

໾ޑੰ᛾ύǶӧύᙴ҂ᆶՋᙴှওᏢҬࢬϐ߻Ǵ໺಍ύᙴόමஒڬᜐઓ

࿶ᐱҥ࣮ࡑǶڬᜐઓ࿶ཞ໾ޑੰރǴ཮ӧ೚ӭੰ᛾ύගϷǴՠࢂϣ৒ࢂ

ණӧܭόӕጇകύǴ٠ؒᐱҥрٰ஑ፕǶύᙴບݯޑ᏾ᡏᢀύǴບᘐϷ ݯᕍ೛ഢϐज़ڋǴу΢ђж໾ࣽЋೌޑНྗǴคݤஒѦ໾ύޑઓ࿶ᘐ໾

ൂᐱೀ౛Ƕ

౜жᙴᏢஒઓ࿶ཞ໾ϩࣁઓ࿶ѨҔǵືँᘐ໾ǵઓ࿶ᘐ໾ΟεᜪǶ ҁჴᡍஒጄൎᕭλԿઓ࿶ᘐ໾ਔǴՋБ౜жᙴᏢஒڬᜐઓ࿶ᘐ໾ޑឦܭ Ѧ໾ޑ΋ঁᕉ࿯Ƕઓ࿶ᘐᚆޑ௃ݩวғਔǴ໪ӧੰΓཞ໾࡚ੱᛙۓࡕǴ

໾αమബֹԋࡕǴω཮຾Չઓ࿶অൺЋೌǶ๱౳ܭઓ࿶ᘐ໾ਔǴவѦ໾

ЇଆޑЬाੰ᛾ύǴђΓჹ࣬ᜢ“ઓ࿶ᘐ໾”ޑᇡ᛽ᆶೀ౛Ƕઓ࿶ᘐ໾ӧ ύᙴޑੰ᛾ϩᜪύǴёឦܭߎየǵମשǵಥՏǵโᘐǵᓸઅ໾ޑጄᛑǶ ύᙴჹӚᅿ“ᘐ”ޑੰ᛾ǴԖਔΨதҔ“๊”ӷٰ߄ҢǴӵે๊Ǵโ๊Ǵ࿶

ે๊฻Ƕ

ബ໾ǵߎየ

ԐӧՋڬࡾࣿਔයǴ൩ς࿶ԖΑ“ബ໾”ޑੰӜǴӵǺȬڬᘶΘԔᘶ

΢ȭǺȨᓐԖബ߾؍ǴيԖᅬ߾੎ȩǶ٠ЪஒѦ໾ϩࣁ໾ǵബǵשǵᘐѤ

ᅿόӕޑཷۺǶҜጥཞ໾ઇ຋Г“໾”ǹҜጥᆶԼԺ೿຋໒Г“ബ”ǹମᓝ

ϘΨȩǴӧȨߎየโ࡚࣬Їภόளۙ՜ংȩύࡰрȨϻߎየཇςࡕǴԼ ԺкᅈǴόளۙ՜ޣǴԜҗ໾๊࿶โǴᄪፁόளൻՉΨǴځየᗨཇǴโ

࡚όளۙ՜ΨǶȩவᐕжύᙴЎ᝘ޑ૶ၩаϷߏයޑᖏ׉ჴ፬ύǴёว

౜“โ”ёவٿБय़ᇡ᛽Ǻځ΋ࢂ੟ကޑ“โ”ǴࡰޑࢂԼԺаϷځۯ՜ޑ

೽ϩǴхࡴߕ๱ܭମޑԼဇǵ໧஥ᆶโጢ฻ǶځΒࢂቶကޑ“โ”Ǵځ܌

ࡰޑࢂโ๎ǵโጢǵโဇǵԼԺϷ೬ମޑᕴᆀǴջΓᡏମᓝڬൎޑҜጥǵ ҜΠಔᙃǵԼဇǵโጢǵᜢ࿯៶ǵྖన៶ǵ໧஥ǵဇᓋǵՈᆅǵڬൎઓ

࿶ǵ෎໔ዬǵᜢ࿯೬ମዬ฻೬ಔᙃ^[231]Ƕ

Ȭϣ࿶ȭᗨฅע΋٤೬ಔᙃᆀࣁ“โ”ǴନԜаѦᗋԖ“โጢ”ǵ“࿶

โ”ǵ“ےโ”฻ӜᆀǴՠ΋ኬ಍ᆀࣁ“โ”ǶӧȬᡫኰΘ࿶โȭᆀࣁΜΒ࿶

โǴځՉوၡጕᆶڬൎઓ࿶ൻՉၡጕ࣬՟Ǵՠߚֹӄ࣬ӕǶԜጇύҭග ϷǺȨ࿶โϐੰǴ……഍࿅όҔȩǵȬનୢΘதڈ࿯ፕȭǺȨੰӧโǴโᠱ

࿯ภǴόёаՉǴӜГโ◰ȩǵȬનୢΘ◰ፕȭǺȨ◰……ӧܭโǴ߾ۙό

՜ȩǶҗԜёـ໾โޑੰ᛾ᆶڬൎઓ࿶ཞ໾ϐੱރԖ΋ۓ࣬ᜢ܄Ƕӧύ ୯ଞءݯᕍᏢ^[230]ύעѦ໾܄ޑᄒᡛឦܭύ୯ᙴᏢ໾โޑጄൎǴઓ࿶ᘐ໾

܌೷ԋޑ໾্ၟ໾โᜢ߯ஏϪǶ

࿅ੰᆶઓ࿶ᘐ໾

ԐӧࡾࣿᏯ୯ਔයǴȬϣ࿶ȭ२Ӄගр“࿅”ޑཷۺǶȬનୢΘғ਻೯ ϺፕȭǺȨӢΪᔸǴ२ӵᇗǴᔸ዗ѲᝎǴεโ೬อǴλโԅߏǴ೬อࣁܥǴ ԅߏࣁ࿅ȩǶȬનୢΘ഍໚ձፕጇȭǺȨΟ഍Ο໚วੰǴࣁୃ࢏๺ܰǴѤަ

όᖐǶȩԜ“࿅”ΏࡰѤަԅ೬ǵคΚϲᖐϐੱރǶځ߄౜ޑੱރᆶઓ࿶

ᘐ໾ϐᖏ׉߄౜Ԗ೚ӭ࣬՟ೀǶቶကޑ࿅ੰΨх֖Α“ᡛᅯ”೭ঁ੯ੰǶ ځΏࡰަᡏ೬১คΚǴԼԺԅ጗όԏǴᜤܭࢲ୏܈ֹӄόૈࢲ୏ԶقǶ Ȭဃᔮᕴᒵȭ^[225]ញГǺȨ៽ᐛᏮආԶόૈԏឪǴ጗߾ԅᕵԶόૈڋނǴ

ࡺځ᛾ѤަόᖐǴโેᜢ࿯คΚǴόё୏ޣǴᒏϐ៽ǹځѤަᗨૈᖐ୏Ǵ Զަ࿯጗১ǴᏧނБૈᙯ୏ޣǴᒏϐ጗Ǵ܈аѰࣁ៽ǴΞࣁ጗ȩǶӧύ ᙴӜຒϣ৒΢ᆶՋᙴϐύኰઓ࿶ੰᡂ܈ᘐ໾Ϸڬൎઓ࿶ޑੰᡂᘐ໾ࣣ

ԖᜢǶЦ᜽ችϷڬ୯ฐ฻^[231]ࣴزύΨගрโ࿅ࢂӢ“аަᡏᠱ࡚ǴۙԶ ό՜ǴᅌԿ๺১όҔࣁЬा߄౜ޑަᡏ࿅ੰᜪ੯ੰǶ”ځަᡏᠱ࡚ϐރ ᆶȠϣ࿶ȡ࣬ӕǴՠᆶȠϣ࿶ȡளϐܭط዗όӕǴԶ“โ࿅”ӭҗдੰ໺

ٰǴ“◰ǵମ◰฻ੰǴߏයޮ׉όଆǴᆒ਻ᖝཞǴโેѨᎦ܌ठ”࿅◰ࢂ“а ѤަЀځࢂΠަ຾Չ܄ഞ◰όϘǵ࿅১คΚǵԼԺ๺ᕭǵόૈᒿཀၮ୏

ࣁЬा߄౜ޑަᡏ࿅ੰᜪ੯ੰǶ”ځੰӢੰᐒ“ӭӢ࿪፟όىǴ܈ࡕϺѨ ፓǴᔸ዗࿀ᐜߔᅉǴโેѨᎦ܌ठ”ǶᡉฅԜ“࿅”ᐒ౛ᆶޤ᠌ᜢ߯ςόࢂ

ٗሶܴᡉǴځวੰόࢂҗܭޤ዗ယขǴԶࢂНనжᖴምᛖǴโેѨᎦǶ ՠךॺவځඔॊύёаளޕၟઓ࿶ཞ໾߄౜рٰੱރΨ΋ۓำࡋޑᜪ

՟Ƕ

2.5 ֤ମઓ࿶ᆶଞءҤՏᔈҔޑ௖૸

ӧઓ࿶ᘐ໾ޑݯᕍ೽ϩǴၸѐύᙴᗨคޔௗගϷǴՠό৒ցᇡޑ

ࢂǴவђжЎ᝘ύǴύᙴჹᘐ᛾ޑݯᕍࢂӭБय़ޑǶᡫኰ࿶ેጇԖϓ"

࿶ેޣǴ܌а،ԝғǴೀԭੰǷፓ຀ჴǶ"Ǵଞءᕍݤֹӄࢂа࿶๎Ꮲ ᇥࣁځ౛ፕ୷ᘵǶΞԖ"࿶ϐ܌ၸǴੰϐ܌ݯǴ"Ϸ"ჱѨځҤǴЙѨځ࿶Ƕ”

฻ڗҤচ߾ǶਥᏵύᙴΜΒ࿶๎کΜΒҜ೽౛ፕǴڀԖ “೯࿶ેǴፓՈ

਻Ǵѳᑽ഍໚Ǵڐፓ᠌๜Ǵן҅០ٕ” ޑфૈǶᖏ׉Бय़ǺЀᏰߏܭࢲ ՈЗภǵѳᑽ഍໚ǵፓ࿶ӼઓǵՉ਻ᄪՈёҔܭёҔܭ਻Ոୃ࢏Ǵ਻ᅉ Ո྿ϐ࿅ੱǵୃᡛȐӵǺᕉၢǵىΟٚǵԔԣǵӝك)^[232-234]Ƕ܌а྽ך ॺԵቾ֤ମઓ࿶ᄒᘐࡕϐଞڈݯᕍǴᒧڗҤၰϐՏ࿼ӧ֤ମઓ࿶܈ځϩ Ѝ΢ࢂၨၸӝޑǶךॺ܌ᒧڗޑҤၰѸሡڀԖΠॊΒ੝ᗺǺ1.Ѹ໪ӧ֤

ମઓ࿶܈ځϩЍ΢ǹ2.ᄒᘐઓ࿶ϐٿୁӚڗ΋ҤၰǴځύǴᄒᘐઓ࿶ᇻ ᆄϐҤၰᆶႝڈᐟϐ഍ཱུ࣬ೱǶ߈жᏢޣ Li ฻^[235]ޑࣴزύளޕၮҔε ႵޑኳࠠଛӝΓᡏޑଞءҤՏѐ૶ᒵځ҃ఋઓ࿶ AĮǵAȕǵAȖǴ่݀ว

౜ଞءҤՏࢂک҃ัઓ࿶ϩѲࢂ΋ठޑǴх֖Πަޑᖌ࿶ǵᆮા࿶ǵग

࿶(ىΟ໚࿶)Ϸط࿶ǵ๠࿶ǵ๝࿶(Οచ഍࿶)೿࣬಄ӝ(კ 2.1)Ƕ

კ 2.1 εႵϷΓᡏଞءҤՏઓ࿶҃ఋϩѲკ^[235]( Li AH. Human acupuncture points mapped in rats are associated with excitable muscle/skin–nerve complexes with enriched nerve endings. Brain Res. 2004; 1012: 156 Fig 2)

2.6 ҁჴᡍ࠻ࣴزԋ݀ӣ៝

ӕਔҁჴᡍ࠻ӧᕳӝઓ࿶Ꮴᆅঅൺڬᜐઓ࿶ӆғሦୱΨளډ೽ϩ ԋ݀(߄ 2.1)ǴЬा٬ҔޑࣴزሦୱၠىΑϯᏢϷނ౛Ǵ௖૸ڈᐟኳԄჹ ܭઓ࿶ӆғޑቹៜǴӕਔךॺΨགྷӆ຾΋؁೸ၸ೭٤ϯᏢ܈ނ౛ޑᡂ ӢǴӆ௖૸ӵՖߦ຾ઓ࿶ӆғǶ

߄ 2.1 ҁჴᡍ࠻ϐ߻܌଺ଞჹઓ࿶ӆғޑࣴز่݀

ࣴزЬᚒ ઓ࿶Ꮴᆅచҹ ӆғԋф౗

ઓ࿶Ꮴᆅ׷፦

ޖ ጤ ᆅ + ᆅ ϣ к ༤ ጤ চ ೈ қ (n=10)

90.0%

ޖጤᆅ+ᆅϣк༤ܴጤ(n=10) 80.0%

ޖጤᆅ+ᆅϣк༤ᆘఙηનҬ ᖄܴጤ(n=10)

80.0%

ᆘఙηનҬᖄܴጤк༤ޖ ጤᆅܭঅៈᄒᘐεႵ֤ମ ઓ࿶ӆғቹៜϐຑ՗^[236]

ޖጤᆅ(n=10) 30.0%

Ѥຼ(n=10) 100%

Ϥຼ(n=10) 100%

аᆘఙηનҬᖄܴጤᇙ೷

फ़ှ܄ઓ࿶Ꮴᆅϐࣴزຑ

՗^[237] Ζຼ(n=9) 100%

΋λਔಔȐn=10ȑ 100%

ΟλਔಔȐn=10ȑ 100%

όӕڰۓࡋϐफ़ှ܄ઓ࿶

ᆅჹӆғઓ࿶фૈࡠൺቹ

ៜϐຑ՗^[238] ѤΜΖλਔಔȐn=10ȑ 100%

ϯᏢ܄ڈᐟ

ޖጤᆅ+αܺѤނ෯(n=9) 55.5%

ޖጤᆅ+αܺ᏾ᡏᕍБ(n=9) 88.8%

ύᙴБᏊჹ࿶ޖጤᆅঅៈ

ϐᄒᘐεႵ֤ମઓ࿶ӆғ

ቹៜϐຑ՗^[239] ޖጤᆅ(n=10) 70.0%

ុ΢।

ಃΟക ׷਑ᆶБݤ

3.1 ׷਑

1. ޖጤ

ҁჴᡍ٬Ҕϐޖጤᆅ(12 mm ߏǴ1.5 mm ϣ৩Ǵ2mm Ѧ৩)ᖼԾ Dow Corning (Saint LouisǴUSA)(კ 3.1)Ƕ

2. ଞءଞ

٬Ҕଞ᎔ 0.5 κ 32 ဦ(12mm ߏǴ0.35mm ޔ৩)ёకԄόឌᒳค๵డ ଞǶ

3. ಔᙃࢉՅ܌٬Ҕޑ Toluidine Blue

Toluidine blue ϯᏢԄࣁ C15H16SCl+ZnCl2ǶѬჹઓ࿶ಔᙃύೈқ፦

ޑᅹ਼୷ԖଯࡋޑᒃӝΚǴӢԜǴ೏ቶݱҔٰ྽բઓ࿶ᡎᓋޑࢉՅᏊǴ

྽а Toluidine blue ࢉՅਔǴᡎᓋ೏ࢉԋుᙔՅǴԶᡎᓋᕉϣޑືँ߾և

౜఩қՅǶჴᡍ܌Ҕޑ Toluidine blue ᖼԾ Sigma (USA)Ƕ 4. 9-0 Nylonᕳጕ

Ҕܭஒᘐ໾ઓ࿶ڰۓܭઓ࿶ᏤᆅǶჴᡍ܌Ҕޑ 9-0 Nylon ᕳጕᖼԾ Mani (Japan)Ƕ

5. Betadine® Antiseptic Solution

Ҕܭჴᡍၸำ୏ނϷᏔఓޑ੃ࢥǶჴᡍ܌Ҕޑ Betadine® Antiseptic Solution ᖼԾ Mundipharma (Germany)Ƕ

6. AErrane® (კ 3.2)

਻ ᡏ ഞ ᎈ Ꮚ Ǵ Ҕ ܭ Ћ ೌ ᇙ ኳ ၸ ำ ෧ ե ୏ ނ ภ ध Ƕ ჴ ᡍ ܌ Ҕ ޑ AErrane®(Isoflurane)ᖼԾ Baxter (USA)Ƕ

7. 4-0 Catgut chrom ᕳጕ

ҔܭᕳӝεႵԼԺϷҜጥǶჴᡍ܌Ҕޑ 4-0 Catgut chrom ᕳጕᖼԾ B. Braun (Germary)Ƕ

8. фૈႝڈᐟᏔ Trio 300(Ito Co.ǴLtd.ǴJapan)(კ 3.3)

Widthࣁ 5 0µsǴCurrent ࣁ 1mAǴᓎ౗ࣁ 2HzǴਔ໔ࣁ 15 ϩដǶ ᏹբБԄ: 1.Ѻ໒ႝྍ 2.ྗഢ຾Չݯᕍ 3.ᒧ᏷ӳݯᕍኳԄ໒ۈ຾Չ ݯᕍ 4.ᒧ᏷ TENS ኳԄ 5.ᒧ᏷ TNS CST(TENS ࡭ុኳԄ)6.ुۓӚ໨ኧᏵ

7.ڈᐟ໒ۈ 8. ่״ݯᕍǶ

9. ਻ᡏഞᎈᐒ(Forawick Vaporizer, Muraco Medical Co., Japan)(კ 3.4)

10. ኧՏឪᒵቹᐒ:ࠠဦ(SONY DCR-HC30 68,Japan) 11. ኧՏԄ࣬ᐒ:ࠠဦ(SONY P150 720,japan)

12. ኧՏቹႽϩ݋س಍:ހҁ(Image-ProLite,Media Cybernetics,USA) 13. ᇨวႝՏሺ(Neuropack Four Mini, Nihon Kohden Co, Japan)(კ 3.5)

კ 3.1 ޖጤᆅ კ 3.2 ਻ᡏഞᎈᛰ

კ 3.3 фૈႝڈᐟᏔ

კ 3.4 ਻ᡏഞᎈᐒ კ 3.5 ᇨวႝՏሺ

3.2 ჴᡍ୏ނϩಔ

ሟ܄ Sprague-DawleyȐSDȑεқႵ 30 ଫǴख़ໆࣁ 280-350 gǴڬស ࣁΜΒຼǴϩࣁΟಔǴϩձࣁ A ಔǺೌࡕҥջႝଞڈᐟǵB ಔǺೌࡕ 8 ВႝଞڈᐟϷ C ಔǺೌࡕ 15 ВႝଞڈᐟǴ؂ಔӚ 10 ଫǶ

ႝғ౛ᔠෳ

A

B

C

ೌࡕ 0 1 8 15 22 29 42 Ϻ

კ 3.6 ჴᡍࢬำკ

3.3 ഞᎈϷ੃ࢥ

Ћೌ߻໪ӃஒεႵഞᎈǴஒεႵ࿼ܭ೸ܴഞᎈጃύǴճҔ਻ᡏഞᎈ

ڈᐟ໘ࢤ ҶᎦ໘ࢤ

ᐒ (Forawick Vaporizer, Muraco Medical Co., Japan) ഞ ᎈ Ǵ ഞ ᎈ Ꮚ ࣁ AErrane® (Baxter, USA)Ǵ߃ଆᏊໆࣁ 5 litter/kgǷminǴࡑεႵܶ଎ࡕǴ ஒεႵԾ೸ܴഞᎈጃύڗрǴճҔ༟ጤᆅᒡଌഞᎈᏊǴԜਔഞᎈᏊໆׯ ࣁ 2 litter/kgǷmin ЪஒԜ༟ጤᆅ঺ܭεႵαሷύǴ࡭ុ๏ϒഞᎈǴ٬ځ ߥ࡭ഞᎈރᄊǶગख़ࡕஒεႵङ೽ޑЛ߹௞Ǵ߹Л୔а Betadine®

(Mundipharma, Germany)ԾύЈ໒ۈҗϣӛѦ੃ࢥΟԛǶ

3.4 Ћೌၸำ

εႵ੃ࢥֹԋࡕǴೌޣӃаܠࡰϷ१ࡰפډεႵѓୁϐިମᓐ΢ε ᙯη(greater trochanter of femur)ϷѦୁلރମ(lateral fabella)ϒаۓՏǴ ٠ҔΘТݮԜٿᗺϐೱጕჄ໒ҜጥǴ໌܄ϩᚆިΒᓐԼ(biceps femoris muscle)ᆶโጢǴෞᚆрߏऊ 2.5 cm ޑ֤ମઓ࿶(კ 3.7)ǴӧຯఛރԼ (piriformis)Πጔ 8 mm ೀǴҔ୊Θ᏾ሸ୊ᘐ֤ମઓ࿶༸(კ 3.8)Ǵڗрς

ྐ๵ϐઓ࿶ᏤᆅǴа 9-0 Nylon ᕳጕܭઓ࿶Ꮴᆅࡕᆄ 5 mm ೀϾࢰΕଞǴ ฅࡕӆऀၸ΋Бᘐᆄϐઓ࿶ѦጢǴௗ๱Ծઓ࿶Ꮴᆅࡕᆄ 2.5 mm ೀϾࢰ

ऀрǴനࡕܭઓ࿶ᏤᆅѦаൂ่ڰۓ(კ 3.9)Ǵ࿶ӭԛ٣߻ޑᕳӝ၂ᡍ᛾

ჴǴᘐᆄઓ࿶཮ྖԿٿᆄѦୁϾࢰՏ࿼ǴԶᇙ೷ 10 mm ޑ໔ຯ(კ 3.10)Ƕ ઓ࿶ᆶઓ࿶Ꮴᆅᕳӝֹ౥ࡕǴஒഞᎈᏊϐࢬໆׯࣁ 1 litter/kgǷminǴ٠ а 4-0 Catgut chrom ᕳӝԼԺϷҜጥǶЋೌֹ౥ࡕǴෳໆεႵᡏख़Ǵ٠ ஒεႵ࿼ӣ᠈ηǴྣӀᆢ࡭ᡏྕǴ฻ࡑ୏ނผᒬǶаלғન

Pamoxicillin^®(ϣ֖ Amoxicillin Trihydrate 1.5 gm/60mlǴᖄٖϯᏢᇙᛰި

ҽԖज़ϦљǴTaiwan)1 g ྋှܭ 100 ml ଍ᅖ೸НύǴ྽բΒϺҽϐН๏

ϒԾҗ໯НǴႣٛ໾αགࢉǶ

კ 3.7 ֤ମઓ࿶ۓՏ კ 3.8 ϩᚆ֤ମઓ࿶

კ 3.9 ᄒᘐ֤ମઓ࿶٠ᕳӝΕ 10mm ޖጤᆅ კ 3.10 εႵЋೌޖጤᆅௗӝკ

3.5 ႝଞڈᐟၸำ

٬Ҕႝଞᐒ(Trio 300ǴIto Co.ǴLtdǴJapan) ࿶Ҝઓ࿶ԼԺႝڈᐟᏔ (TENS)ኳԄǴॄཱུǵཱུ҅ᒡрጕϩձ֨ܭᕉၢ(߈ᆄ)ǵ໚ഊࢨ(ᇻᆄ)Ҥ Տ΢ϐడଞଞ࢓΢ǴڈΕుࡋऊ 0.5-1.0cmǴᒿջᒡΕೱុБ׎ݢǴႝࢬ மࡋаԼԺр౜ᇸ༾ܜ୏ऊ 1mA ࣁྗǴᓎ౗ࣁ 2HzǴ؂ԛڈᐟਔ໔ࣁ 15 ϩដǴ؂ຼΟԛǶҁჴᡍࣁᗉխഞᎈਔ໔ৡ౦Ǵ೷ԋჴᡍ่݀ޑቹៜ ӢηǴךॺճҔೂ׎ᆅಔௗԋ፾ӝѤଫ୏ނӕёаௗڙഞᎈޑБԄǴӕ ਔ຾Չჴᡍ(კ 3.11Ǵკ 3.12)ǶӧЋೌࡕ႖Вǵ8 ВࡕϷ 15 ВࡕϟΕႝ

ଞڈᐟǴ΋ຼΟԛǴ؂ಔௗೱុڈᐟٿຼǴӅᐕਔϤຼࡕஒ୏ނ឴࣊Ƕ

კ 3.11 ႝଞڈᐟ߻ഞᎈ

კ 3.12 ႝଞڈᐟၸำഞᎈ

3.6 ୏ނଞءҤՏޑᒧڗ

3.6.1 ! ᕉၢ(Huan Tiao)! GB30

ىϿ໚ᖌ࿶ىϿ໚Ϸϼ໚ٿેҬ཮

҅ӜǺᕉၢ {ଞءҘΌ࿶}

ձӜǺᢇମ{ઝ໺தξླྀལᗿଞءӄਜ},ϩύ{ଞБϤ໣},ᕉك,ㆃኰ {ύ୯ଞءᏢ}

ᘜ࿶ǺឦىϿ໚ᖌ࿶Ƕ

ჴᡍڗҤǺӧᖊѦୁΠ೽Ǵ྽ިମεᙯηсᗺᆶ䆪ମ຋ϾೱጕޑѦ 1/3ᆶύ 1/3 ҬᗺೀǶୁޮǴ՜ΠᆲǴۙ΢ᆲڗҤǶ(֤ମઓ࿶߈ᆄೀ)

ֽ೽ှওǺ

ךॺүྣचϡߝჴҔ୏ނଞءЋн܌ගϷޑଞءҤՏ(კ 3.13*Ǵଛ ӝΓᡏှওޑՏ࿼ٰ຾΋؁ڗךॺ܌௦ҔޑҤၰǴΨ൩ࢂᄒᘐεႵ֤ମ ઓ࿶ٿᆄޑ߈ᆄᕉၢҤϷᇻᆄ໚ഊࢨҤǶ

კ3.13 εႵҤՏკ

3.7 ୏ނႩᎦᕉნ

ჴᡍ୏ނϐႩᎦᕉნࣁޜፓ܊໔Ǵ΋ঁ༟ጤ᠈ηႩᎦ΋ଫεႵǴྕ

ࡋᆢ࡭ 22±3ʚǴ࣬ჹྒྷࡋ 55±5%ǴъВྣᕉნǴԾҗ໯НϷᗯᎦ኱ྗ

εႵჴᡍႩ਑(ᅽტϦљǴѠ᡼)Ƕ

3.8 ၗ਑ԏ໣Ϸϩ݋Бݤ

3.8.1 ᢀჸჴᡍεႵѦ߄ϐᡂϯ

୏ނ឴࣊߻Ǵӧ΢ॊႩᎦᕉნύႩᎦεႵǴ٠ᢀჸεႵޑ໯१ǵε λߡǵ໾αǵЛՅǵࢲ୏௃׎ǵӸࢲ௃׎ǵى೩Ծූ฻Ƕ

3.8.2 ᢀჸӆғ֤ମઓ࿶ԋфޑ่݀

឴࣊߻ӃஒεႵഞᎈǵ߹ЛǵBetadine^®੃ࢥࡕǴۓՏрεႵѓୁϐ

ިମᓐ΢εᙯηϷѦୁلރମǴݮԜٿᗺϐೱጕҔΘТჄ໒ҜጥǴ໌܄

ϩᚆިΒᓐԼᆶโጢǴڗрޖጤᆅ຾΋؁ຑ՗ࢂցԖқՅጤރނ፦೯ ၸǴаԜዴۓࢂցઓ࿶ӆғԋфǶ

3.8.3 ಍ीϩ݋

ஒӚಔόӕႝଞڈᐟϟΕᗺεႵޑઓ࿶ӆғ่݀଺಍ीϩ݋ǴճҔ SAS 6.12 ހ಍ी঺း೬ᡏǴ௦ьБᔠۓ(Chi-Square)Ǵ௖૸Ӛಔၗ਑ӧܭ Ԝ٤٣ҹύԖค಍ी΢ᡉ๱ৡ౦Ǵᔠۓၸำύऩว౜ҺՖ΋ಒ਱ϣޑ౛

ፕԛኧλܭ 5Ǵ߾௦Ҕ຤ഓᅟᆒዴཷ౗ᔠۓ(Fisher’s exact test)Ǵҁჴᡍ

಍ी΢ᔠۓޑಃ΋ᇤৡ೛ӧ 0.05Ǵऩ Pɦ0.05 ߾ᇡۓԖ಍ी΢ޑܴᡉৡ ౦Ƕ

3.8.4 ӆғઓ࿶ಔᙃϪТຑ՗

εႵ឴࣊ࡕǴஒઓ࿶Ꮴᆅϣӆғޑઓ࿶ಔᙃೱӕઓ࿶ᏤᆅڗΠǴ੆

ݰܭ 2.5%glutaraldehyde НྋనΟϺǴڗрϣԖӆғઓ࿶ಔᙃϐઓ࿶Ꮴ ᆅǴஒځ฻ϩࣁΟ฻ϩǴճҔΘТϩձѐନ߻ࡕΟϩϐ΋Ǵ੮Πύ໔Ο ϩϐ΋ޑ೽ϩ࿼ܭ 2.5%glutaraldehyde НྋనύǴӆஒӆғઓ࿶ಔᙃа

֖ 2.5%glutaraldehydeǵ4%Paraformaldehyde Ϸ 0.1 M cacodehyde షӝన ڰۓऊ 1~2 ВǴᒿջஒઓ࿶а 1%OsO4 ࡕڰۓऊΒλਔǴϐࡕǴа 50~100%ଚᆒಥНǴӆаᐋિхশǴ٠ஒ֖ӆғઓ࿶ಔᙃϐᐋિ࿼Ε 60~70ʚ੘ጃύऊ 16 λਔǴࡑᐋિฯϯǶᒿࡕஒхশϐӆғઓ࿶ಔᙃբ ᐉӛ 1 ȝm ϪТࡕǴа Toluidine blue ࢉՅǴ྽ಔᙃϪТࢉՅࡕǴᡎᓋᆶ Schwann cell ཮ܴᡉևՅǶᡉ༾᜔ 40 ७ΠǴܡΠӆғઓ࿶ಔᙃϪТӄඳǶ ᡉ༾᜔ 400 ७ΠǴёమཱ࣮ډՈᆅǴځ፾ӝቹႽϩ݋೬ᡏᆶीᆉӆғઓ

࿶ಔᙃύՈᆅኧǶ

3.8.5 ӆғઓ࿶ಔᙃᏢۓ܄ϩ݋

ஒ ಔ ᙃ Ϫ Т ࿼ ܭ 40~400 ७ ϐ Ӏ Ꮲ ༾ ᜔ Π ᢀ ჸ (Olympus IX70, Olympus Optical Co., Ltd, Japan)Ǵӆғઓ࿶ಔᙃϪТޑᢀჸख़ᗺӵΠǺ(1) ӆғઓ࿶᏾ᡏ่ᄬࢂցֹ᏾Ǵઓ࿶ѦጢǴൎઓ࿶ጢаϷઓ࿶ϣጢࢂցς ߏԋ(2)ӧઓ࿶ϣጢύࢂցԖᡎᓋϯືँғԋǴ܈ޣε೽ϩಔᙃύϝѝԖ ᠼᆢ҆ಒझ܈Schwanncell Զς(3)Ոᆅܭӆғઓ࿶ಔᙃύࢂցς׎ԋǶ

3.8.6 ӆғઓ࿶ಔᙃᏢۓໆϩ݋

ჹӆғઓ࿶ಔᙃϪТӃаௗܭᡉ༾᜔ޑኧՏ࣬ᐒ ȐNikon Coolpix 950, JapanȑܡΠኧՏቹႽǴӆճҔறՅቹႽϩ݋೬ᡏ ȐImage-Pro Lite

Version 3.0, Media Cybemestics, USAȑբीᆉǴ٠а၂ᆉ೬ᡏ Microsoft Excel XP଺ϩ݋Ƕीᆉᆶϩ݋ϪТޑӆғઓ࿶ޑӄ೽य़ᑈǵઓ࿶ϣጢय़ ᕮǵઓ࿶ືँኧҞǵઓ࿶ືँѳ֡य़ᑈǵઓ࿶ືँஏࡋǵઓ࿶ືँय़ᑈ ԭϩКǵӆғՈᆅኧҞǵӆғՈᆅᕴय़ᑈǵӆғՈᆅय़ᑈԭϩКǶ ઓ࿶ӄ೽य़ᑈीᆉБԄ(Total Area)

ஒϪТ࿼ܭ 40 ७ᡉ༾᜔ΠǴаኧՏ࣬ᐒܡឪቹႽǴӆаႝတ୮ᒧ ઓ࿶ѦጢڬൎǴႝတ཮Ծ୏ीᆉр᏾ঁઓ࿶ӄ೽य़ᑈǶ

ઓ࿶ϣጢय़ᑈޑीᆉБԄ(Endo. Area)

ஒϪТ࿼ܭ 40 ७ᡉ༾᜔ΠǴаኧՏ࣬ᐒܡឪቹႽǴӆаႝတ୮ᒧ ઓ࿶ϣጢڬൎǴႝတ཮Ծ୏ीᆉр᏾ঁઓ࿶ϣጢӄ೽य़ᑈǶ

ઓ࿶ືँኧҞ(Axon number)

ஒϪТ࿼ܭ 400 ७ᡉ༾᜔ΠǴᒿᐒᒧڗઓ࿶ϣጢϐύѧϷڬᜐӚ 2

ঁѤБ׎ޑ୔༧ǴаኧՏ࣬ᐒڗрቹႽǴीᆉрԜ 4 ୔༧ϣޑઓ࿶ືँ

ኧǴӆᆉрԜ 4 ୔༧ϐय़ᑈǶӵԜǴ൩ёаа 4 ୔༧ࣁ୷ྗǴ٩Кٯᆉ рઓ࿶ϣጢϣ܌֖ϐᕴઓ࿶ືँኧǶ

ઓ࿶ືँѳ֡य़ᑈ(Mean axon area)

ӕઓ࿶ືँᒧڗϐ4୔༧ǴᆉрԜ4୔༧ϣ܌Ԗޑືँय़ᑈ(όӝᡎᓋ) ࡕǴନа4୔༧ϣϐືँኧҞǴԜջࣁືँϐѳ֡य़ᑈǶ

ઓ࿶ືँஏࡋ(axon density)

ஒઓ࿶ືँኧନаઓ࿶ϣጢय़ᑈǶ

ઓ࿶ϣጢय़ᑈ՞ӆғઓ࿶ӄ೽य़ᑈԭϩК(Perecentage of total axon Area in Endo. Area(%))

ஒઓ࿶ϣጢय़ᑈନаઓ࿶ӄ೽य़ᑈǶ ӆғՈᆅኧҞޑीᆉБԄ(B.V.number)

ஒϪТ࿼ܭ 400 ७ᡉ༾᜔ΠǴаኧՏ࣬ᐒܡឪ܌Ԗӆғઓ࿶ಔᙃ

ࠠᄊǴӆ೴΋ीᆉр܌ԖკТ܌֖ϐՈᆅኧҞǶ ӆғՈᆅᕴय़ᑈޑीᆉБԄ(B.V. area)

ஒϪТ࿼ܭ 400 ७ᡉ༾᜔ΠǴаኧՏ࣬ᐒܡឪ܌Ԗӆғઓ࿶ಔᙃ

ࠠᄊǴӆ೴΋ीᆉр܌ԖკТ܌֖ϐՈᆅϐय़ᑈǶ

ӆғՈᆅय़ᑈԭϩКޑीᆉБԄ(Perecentage of total B. V. in nerve

Area(%))

ஒӆғՈᆅᕴय़ᑈନаઓ࿶ӄ೽य़ᑈǴӆඤᆉࣁԭϩКǶ

಍ीϩ݋

ճҔ SPSS 10.0 ހ಍ी঺း೬ᡏǴ௦ൂӢηᡂ౦ኧϩ݋ ȐOne-way ANOVAȑǴ௖૸Ӛಔၗ਑ኧᏵӧ಍ी΢Ԗคৡ౦Ǵҁჴᡍ಍ी΢ᔠۓޑ

ಃ΋ᇤৡ೛ӧ 0.05Ǵऩ Pɦ0.05 ߾ᇡۓԖ಍ी΢ޑܴᡉৡ౦Ƕ྽Οಔޑ ᡉ๱ৡ౦ӸӧਔǴӆа Tukey ݤ଺٣ࡕКၨǴᔠۓᡉ๱ৡ౦Ӹӧব 2 ಔ ϐ໔Ƕ

3.8.7 ႝғ౛ᔠෳϩ݋่݀

ϩᚆрߕܭ⅂ମϐިΒᓐԼǵ๢ဉԼаϷߕ๱ܭ֤ମઓ࿶ϩЍڬൎ ϐિެቫǴ٠аᇨวႝՏሺ ȐNeuropack Four Mini, Nihon Kohden Co.

Japanȑբࣁઓ࿶ԼԺፄӝ୏բႝՏϐᇨวǴځ؁ᡯӃа҅ॄइᒵႝཱུ

Ȑrecording electrodeȑϩձකΕઓ࿶Ꮴᆅᇻᆄϐ⅂߻ԼԼဇϷԼဎೀ(კ 3.14)Ǵќஒڈᐟႝཱུ Ȑstimulating electrodeȑ࿼ܭઓ࿶Ꮴᆅ߈ᆄ(კ 3.15)Ǵӧڈᐟႝཱུញܫр࣬ӕႝࢬڈᐟ Ȑ6 mAȑࡕǴ࿶ၸӆғઓ࿶ಔ ᙃޑ໺ᏤǴܭᇨวႝՏሺ΢ёᡉҢઓ࿶ԼԺፄӝ୏բႝՏݢ׎Ǵइᒵ٠

ीᆉрځౢғԼԺፄӝ୏բႝՏϐወҷය Latency 1(L1) ǵወҷය Latency2(L2) ǵݢය(Duration) ǵਁᅽ(Amplit)ǵय़ᑈ(Area)ǵઓ࿶໺Ꮴ ೲࡋ(MCV)ϐॶǶ

Latency1(ms):ࣁڈᐟԿ໒ۈϸᔈ(take-off point)܌ሡϐਔ໔Ƕ Latency2(ms):ࣁڈᐟԿಃ΋ঁݢঢ়܌ሡϐਔ໔Ƕ

ݢය(ms):ࣁݢ໒ۈᡂϯډࡠൺԿ୷ጕ܌ሡाϐਔ໔Ƕ

ਁᅽ(mv):ࣁനଯݢঢ়ᆶനեݢঢ়ϐຯᚆǶ य़ᑈ(mvms):ਁ൯کݢයޑᕴکǶ

ઓ࿶໺Ꮴೲࡋ(m/s):ൂՏਔ໔ϣ܌ૈ໺ᏤޑຯᚆǶ

კ 3.14 इᒵႝཱུ კ 3.15 ڈᐟႝཱུ

಍ीϩ݋

ճҔ SPSS 10.0 ހ಍ी঺း೬ᡏǴ௦ൂӢηᡂ౦ኧϩ݋ȐOne-way ANOVAȑǴ௖૸Ӛಔၗ਑ኧᏵӧ಍ी΢Ԗคৡ౦Ǵҁჴᡍ಍ी΢ᔠۓޑ

ಃ΋ᇤৡ೛ӧ 0.05Ǵऩ Pɦ0.05 ߾ᇡۓԖ಍ी΢ޑܴᡉৡ౦Ƕ྽Οಔޑ ᡉ๱ৡ౦ӸӧਔǴӆа Tukey ݤ଺٣ࡕКၨǴᔠۓᡉ๱ৡ౦ӧব 2 ಔϐ ໔Ƕ

ಃѤക ่݀

4.1 ֤ମઓ࿶ԋф౗่݀ϩ݋

4.1.1 ޖጤᆅѦᢀᢀჸ

ᄒᘐઓ࿶ࡕϤຼǴഞᎈӕ׷਑ᆶБݤǴ߹ЛࡕǴܭѓΠަࡕѦୁᕵ ՉϪ໒ҜጥǴஒިΒᓐԼϷޖጤᆅѦ೽ϐᠼᆢಔᙃগᚆǴ٬෌ΕεқႵ ޑޖጤᆅኪ៛(კ 4.1)Ǵޖጤᆅٿୁёа࣮ډԖ໳ፃՅޑᠼᆢಔᙃ׎ԋǶ

კ 4.1 εႵޖጤᆅኪ៛

่݀ӵΠ(߄ 4.1)Ǻ

A ಔೌࡕ႖Вႝଞڈᐟ 10 ଫύǴ3 ଫӧޖጤᆅύ೿ёـқՅӆғᆅ ރނ೯ၸǶB ಔೌࡕ 8 Вႝଞڈᐟ 10 ଫύǴ7 ଫӧޖጤᆅύ೿ёـқՅ ӆғᆅރނ೯ၸǶC ಔೌࡕ 15 Вႝଞڈᐟ 10 ଫύǴ4 ଫӧޖጤᆅύ೿

ёـқՅӆғᆅރނ೯ၸǶ

4.1.2 Ӛಔઓ࿶ӆғԋф౗

ઓ࿶ᆅϣԖқՅӆғᆅރނ೯ၸޣǴຎࣁઓ࿶ಔᙃӆғԋф(კ 4.2)ǶӧԜۓကΠǴךॺว౜࿶ၸϤຼޑჴᡍࡕǴӚಔޑԋф౗ϩձࣁ A ಔೌࡕ႖Вႝଞڈᐟ 3/10 (30%)ǵB ಔೌࡕ 8 Вႝଞڈᐟ 7/10 (70%)ǵ C ಔೌࡕ 15 Вႝଞڈᐟ 4/10 (40%)Ƕךॺว౜ೌࡕ 8 Вႝଞڈᐟಔޑઓ

࿶ӆғԋф౗(70%)ଯܭೌࡕ႖Вႝଞڈᐟಔ(30%)Ϸೌࡕ 15 Вႝଞڈ ᐟಔ(40%)ǴԶځύೌࡕ 15 Вႝଞڈᐟಔ(40%)ޑӆғԋф౗Ξౣଯܭ

ೌࡕ႖Вႝଞڈᐟಔ(30%)Ƕ

კ 4.2 ઓ࿶ӆғԋфკǶޖጤᆅٿୁԖቚғޑᠼᆢಔᙃ׎ԋǴύ໔ёـ΋қՅӆғ ᆅރނ೯ၸ(ጂᓐೀ)ǴаԜۓကࣁઓ࿶ӆғԋфǶ

კ 4.3 ઓ࿶ӆғѨ௳Ǵઓ࿶ᆅϣคқՅӆғᆅރނ

߄ 4.1.Ӛಔઓ࿶ӆғԋф௃ݩ

ಔ ձ ጓဦ ઓ࿶ӆғԋфᆶց

A1 ค

A2 ค

A3 Ԗ

A4 ค

A5 ค

A6 ค

A7 ค

A8 ค

A9 Ԗ

ೌࡕ႖Вႝଞڈᐟ

A10 Ԗ

B1 Ԗ

4.1.3 Ӛಔઓ࿶ӆғԋф౗಍ीϩ݋

ᢀჸႝଞڈᐟϟΕਔ໔ᗺჹઓ࿶ӆғϐቹៜ(߄ 4.2)ǴӢᔠۓၸำύ ว౜Ԗಒ਱ϣޑ౛ፕԛኧλܭ 6Ǵךॺ௦Ҕ຤ഓᅟᆒዴཷ౗ᔠۓ(Fisher’s exact test)ٰ଺಍ी΢ޑᔠۓǶA ಔೌࡕ႖Вႝଞڈᐟӆғԋф౗ࣁ 30%ǴB ಔೌࡕ 8 Вႝଞڈᐟӆғԋф౗ࣁ 70%ǵC ಔೌࡕ 15 Вႝଞڈ ᐟӆғԋф౗ࣁ 40%ǴA ಔჹ B ಔǵB ಔჹ C ಔϷ A ಔჹ C ಔ֡ค಍

ी΢ᡉ๱ޑཀက(߄ 4.3)ǴᇥܴႝଞڈᐟޑϟΕਔ໔ᗺჹઓ࿶ӆғ౗ޑቹ ៜ٠ؒԖ಍ी΢ᡉ๱ޑৡ౦Ƕ

߄ 4.2 Ӛಔᓎ౗ᆶઓ࿶ӆғ่݀߄ ઓ࿶ӆғ

! ԖԖ ค Total

Aಔ

ೌࡕ႖Вႝଞڈᐟ 3 7 10

Bಔ

ೌࡕ 8 Вႝଞڈᐟ 7 3 10 Cಔ

ೌࡕ 15 Вႝଞڈᐟ 4 6 10

Total 14 16 30

4.1.4 ႝଞڈᐟϟΕਔ໔ᗺᆶઓ࿶ӆғԋфϐ಍ीϩ݋Кၨ

ᖏ׉΢ᙴৣჹܭ٬ҔႝଞޑݯᕍϟΕਔ໔ᗺǴӭኧؒԖ΋ۓޑೕጄ ᆶፕॊǴךॺ၂๱வҁჴᡍޑ่݀ѐפډႝଞݯᕍޑϟΕਔ໔ᗺጄൎǴ ຑ՗ઓ࿶ӆғޑӚБय़ቹៜǴଞჹҁჴᡍᄒᘐεႵ֤ମઓ࿶ 10 mm ࡕ٬

Ҕޖጤᆅ׷፦ઓ࿶ᏤᆅޑჴᡍኳࠠΠǴךॺஒઓ࿶ӆғޑԋф౗٩ྣઓ

࿶ᄒᘐࡕޑႝଞڈᐟޑϟΕਔ໔ᗺբჴᡍಔձޑࣚۓǴճҔ຤ഓᅟᆒዴ

ཷ౗ᔠۓ(Fisher’s exact test)଺಍ी΢ޑᔠۓǴຑ՗ႝଞڈᐟϟΕޑਔ໔ ᗺჹઓ࿶ޑӆғԋф౗ࢂցڀԖৡ౦܄ቹៜǴჴᡍኧᏵ᏾౛ӵΠ߄(߄ 4.3ǵ4.4ǵ4.5)ǶҗԜךॺளډ೽ҽ่ፕǴႝଞڈᐟϟΕޑਔ໔ᗺჹܭઓ

࿶ӆғޑԋф౗Ǵ٠όڀԖ಍ी΢ޑᡉ๱ৡ౦Ƕ

߄ 4.3 A ಔᆶ B ಔઓ࿶ӆғ಍ी࣬ᜢ߄

಍ीБݤࣁ Fisher’s exact test ; *ǺP<0.05

߄ 4.4 B ಔᆶ C ಔઓ࿶ӆғ಍ी࣬ᜢ߄

಍ीБݤࣁ Fisher’s exact test ; *ǺP<0.05

߄ 4.5 A ಔᆶ C ಔઓ࿶ӆғ಍ी࣬ᜢ߄

಍ीБݤࣁ Fisher’s exact test ; *ǺP<0.05

4.2 Ѧӧᢀෳᆶຑ՗่݀

ӧ֤ମઓ࿶ᄒᘐࡕ΋ຼϣǴεқႵѓࡕަԖܴᡉޑᡛᅯ౜ຝǴՉ୏

΢а߻ަϷѰࡕަࣁЬǴܦԕ๱ѓࡕަԶՉǴ؁ᄊόᛙǴԖਔࣗԿᓉᓉ Ӧ፲ᕭӧ΋فပǶၸΑΟຼࡕՉ୏ᄌᄌࡠൺ҅தǴՠ᏾ᡏՉ୏΢ޑׯᡂ ٠όӭǶ

4.2.4 ЛՅБय़

ઓ࿶ᄒᘐࡕǴ߹Л୔ᒿਔ໔܎ߏ೴ᅌߏр҅தႵЛǹԴႵЛՅᒿਔ ໔ቚߏ೴ᅌҗচҁӀᐛޑқՅᙯࣁ఩໳คᐛǴ٠Ԗಥပޑ௃ݩǶ

4.2.5 ى೩Ծූ

ઓ࿶ᄒᘐࡕǴεႵഌុԖԾූޑ౜ຝวғǶךॺว౜ೌࡕ 15 Вႝ

ଞڈᐟಔޑԾූ౗ଯԾූރݩҭၨᝄख़Ƕೌࡕ႖Вႝଞڈᐟಔӧೌࡕ႖ ВջԖԾූ౜ຝวғ(A3)Ǵᒿ๱ႝଞڈᐟϟΕǴԾූ౜ຝഌុวғ(A5ǵ A2ǵA9ǵA1)Ƕೌࡕ 8 Вଞڈಔӧೌࡕ 7 В(ႝଞڈᐟϟΕ߻)ҭԖϿኧ (B10ǵB5ǵB2)วғԾූǴӧႝଞϟΕࡕҭр౜Ծූ౜ຝ(B1)Ƕೌࡕ 15 Вႝଞڈᐟಔӧೌࡕ 14 В(ႝଞڈᐟϟΕ߻)ҭԖϿኧ(C8ǵC4)วғԾ

ූǴႝଞϟΕࡕҭр౜Ծූ౜ຝ(C2ǵC6ǵC3ǵC7)ǴԾූރݩᝄख़Ǵࠈ

໾ᄒᘐઓ࿶ୁޑى೩Ǵ೷ԋрՈᆶ໾αǴ຾΋؁Ԗ٤ᝄख़೷ԋى೩ޑᘐ

຋ᆶᡂ׎ǴࣗԿࠈ໾ىඓǶ

კ 4.5 εႵى೩Ծූ߃ය—೩Ҙᘐ຋ კ 4.6 εႵى೩Ծූύය—ى೩੃Ѩ

კ 4.7 εႵى೩Ծූ҃ය—ىඓ೽ϩ੃Ѩ კ 4.8 C5 ӢᓸΚᏤठಥЛ

4.2.6 ႝଞڈᐟ

ךॺว౜྽٬Ҕ 1 mAǵ2Hz ႝڈᐟਔεႵԼԺ΢Ԗᇸ༾ޑၢ୏Ƕ

4.2.7 ໾αБय़

ೌࡕ๏ϒלғન Pamoxicillin® 1 g ྋှܭ 100 ml ଍ᅖ೸Нύ๏ϒԾ җ໯НǴႣٛ໾αགࢉǴӚಔ୏ނ໾αଳృନΑ A6 ѦǴᘰӝ௃ݩؼӳǴ คགࢉޑ௃׎วғǶA6 ߾ࢂӧЋೌࡕ߻ΟϺ໾αᘰӝัᄌǴՠคܴᡉ ᅖрనϷՈНǴёૈࢂ໾αነᔔ᠈ηᏤठǴՠค຾΋؁གࢉރݩǴϐࡕ

໾αࡠൺΨΜϩؼӳǶA1 ӧ߃ය໾α٠คܴᡉ౦ރǴՠӧೌࡕ 10 Ϻ໾

αр౜ᇸ༾วݹआဍ౜ຝǴӧೌࡕ 12 Ϻ໾αр౜ᇸ༾ውᅬǴёૈࢂ໾

αነᔔ᠈ηᏤठǶ

߄ 4.6 Ѧӧᢀෳᆶຑ՗่݀߄

A10 221ʳ 223ʳ

఩໳

B10ʳ 199ʳ 268ʳ

఩໳ ؼӳ

C7ʳ 229ʳ 243ʳ ఩໳ ค Ԗ

C8ʳ 271ʳ 270ʳ ఩໳ Ԗ Ԗ

C9ʳ 258ʳ 264ʳ ఩໳ Ԗ ค

ڈ ᐟ

C10ʳ 251ʳ 259ʳ ఩໳ ค ค

4.2.8 ஒᓎ౗ᆶԾූঁኧ଺࣬ᜢ಍ीϩ݋

ϩ݋ΟಔόӕႝଞڈᐟϟΕਔ໔ᗺεႵࢂց཮ቹៜԾූ่݀ǴA ಔ

ೌࡕ႖ВႝଞڈᐟԾූ౗ࣁ 50%ǴB ಔೌࡕ 8 ВႝଞڈᐟԾූ౗ࣁ 40%ǵC ಔೌࡕ 15 ВႝଞڈᐟԾූ౗ࣁ 70%ǴC ಔԾූ౗ଯܭ A ಔϷ B ಔǴЪԾූރݩҭၨᝄख़ǴճҔ຤ഓᅟᆒዴཷ౗ᔠۓ(Fisher’s exact test)

ٰ଺಍ी΢ޑᔠۓǴว౜٠ค಍ी΢ᡉ๱ཀကǶ

߄ 4.7 ӚಔԾූރݩ Ծූᆶց

! ԖԖ ค Total Ծූ౗

Aಔ

ೌࡕ႖Вႝଞڈᐟ

5 5 10 50%

Bಔ

ೌࡕ 8 Вႝଞڈᐟ 4 6 10 40%

Cಔ

ೌࡕ 15 Вႝଞڈᐟ 7 3 10 70%

Total 16 14 30

4.3 ӆғઓ࿶ಔᙃᏢۓ܄ϩ݋่݀

4.3.1 ҅தεႵ֤ମઓ࿶Ϫय़ϐඔॊ

֤ମઓ࿶ϐനѦቫࣁઓ࿶Ѧጢޑጏஏ่ጌಔᙃ܌хൎǴځϣԖ2ɡ3

ঁઓ࿶ᠼᆢ״Ǵ؂״ઓ࿶ᠼᆢࣁઓ࿶ጢޑ่ጌಔᙃᓋ܌хൎǴӧ؂ঁઓ

࿶ᠼᆢϐ໔ޑࢂ᚞ಒޑ่ጌಔᙃᆀࣁઓ࿶ϣጢǴઓ࿶ϣጢϣ֖Ԗڀᡏᓋ ޑઓ࿶ᠼᆢǵՈᆅǵరЃᆅ฻(კ4.9)Ƕ྽аToluidine blueࢉՅਔǴᡎᓋ

೏ࢉԋుᙔՅǴԶᡎᓋᕉϣϐືँ߾և౜ၨ఩қޑᚑՅ(კ4.10)Ƕ

კ4.9҅தεႵ֤ମઓ࿶ᐉϪय़Ǵܭᡉ༾᜔ΠޑѦᢀǴёـനѦቫҗઓ࿶Ѧጢ܌

хᙟ(εጂᓐ܌ࡰೀ)ǴځϣԖΒঁઓ࿶ᠼᆢ״(λጂᓐ܌ࡰೀ)Ǵϟܭઓ࿶״ϐ໔ޑࢂ

ൎઓ࿶ጢǶ(scale bar=1 mm)

კ4.10ᡉ༾᜔Πϐ҅தεႵ֤ମઓ࿶ᐉϪय़ǴځϣёـՈᆅ(εጂᓐ܌ࡰೀ)Ϸ֖

ᡎᓋϐઓ࿶ᠼᆢǴаToluidine blueࢉՅਔǴᡎᓋ೏ࢉԋుᙔՅ (λጂᓐ܌ࡰೀ)ǴԶ ᡎᓋᕉϣϐືँ(ύጂᓐ܌ࡰೀ)߾և౜ၨ఩қޑᚑՅǶ(scale bar=10 µm)

4.3.2 ޖጤᆅϣқՅӆғᆅރނϪय़ϐᢀჸ

ஒӚಔޖጤᆅύϐڀԖֹ᏾ޑқՅӆғᆅރނ(ؒԖԋфߏၸѐޑ ௨ନ)Ǵڗύࢤ଺ڰۓǵಥНǵхশǵϪТǵࢉՅࡕǴځϪТᢀჸε೿ς

׎ԋ೚ӭᡎᓋϯޑືँǶӚঁᡎᓋϯືँޑஏࡋǵय़ᑈελό΋Ǵಔᙃ ύ٠ԖՈᆅǵઓ࿶Ѧጢǵൎઓ࿶ጢϷઓ࿶ϣጢ฻่ᄬǶӚঁӆғઓ࿶ಔ ᙃǴ٩ᡎᓋϯືँஏࡋଯեޑόӕǴځӆғಔᙃޑԋዕࡋ཮Ԗ܌ৡձ(߄ 4.8)Ƕ

ӧᡉ༾᜔40७ΠᢀჸǴΟಔ֡ёـ΋ֹ᏾ޑઓ࿶ѦጢϷൎઓ࿶ጢǴ ՠࢂᒿ๱ႝଞڈᐟޑϟΕਔ໔ຫఁ܌ӆғޑઓ࿶ϣጢޑय़ᑈຫεՠค

಍ी΢ৡ౦(კ4.11)Ƕ

ӧᡉ༾᜔100७ΠǴՈᆅޑቚғރݩаೌࡕ8Вႝଞڈᐟന٫Ǵᡉ

๱ӭܭೌࡕ႖ВႝଞڈᐟಔǴೌࡕ8ВႝଞڈᐟಔޑՈᆅܴᡉޑቚуЪ ӆғޑՈᆅКၨஏ໣(კ4.12)Ƕ

ӧᡉ༾᜔400७Πว౜όᆅࢂব΋ಔઓ࿶ϣጢϣ߾೿֖Ԗڀᡎᓋޑ ઓ࿶ᠼᆢϷՈᆅ฻ǴځύBಔೌࡕ8Вႝଞڈᐟ֖ઓ࿶ᠼᆢޑᡎᓋၨεЪ ஏ໣ǴᡎᓋᕉനࠆϷֹ᏾ǴϿԖޜݰǹAಔೌࡕ႖Вႝଞڈᐟ֖ઓ࿶ᠼ ᆢޑᡎᓋၨλЪ᚞ණǴᡎᓋᕉΨၨᖓϷόֹ᏾ǴޜݰКၨӭ(კ4.13)Ƕ όᆅࢂব΋ಔޑઓ࿶ѦጢϷൎઓ࿶ጢ೿֖Ԗᠼᆢ҆ಒझ੆ዎǴઓ࿶״ύ Ψ೿֖೚ܮಒझ຾Չઓ࿶অៈǶ

A9-40X B7-40X C3-40X

კ 4.11 Ӛಔӧ 40 ७Πᡉ༾᜔ᢀჸǶ(1)A9 ೌࡕ႖Вႝଞڈᐟಔ(2) B7 ೌࡕ 8 В

ႝଞڈᐟಔ (3)C3 ೌࡕ 15 ВႝଞڈᐟಔǴӧ 40 X ޑᡉ༾᜔ᢀჸΠǴёـ΋ֹ᏾ޑ ઓ࿶Ѧጢ(εጂᓐೀ)Ϸઓ࿶ϣጢ(λጂᓐೀ)Ǵϟܭځύࣁൎઓ࿶ጢǴӕਔว౜ӆғޑ ઓ࿶ϣጢޑय़ᑈ C ಔౣεܭ B ಔک A ಔǶ(scale bar 200 µm)

A9-100X B7-100X

C3-100X

კ 4.12 Ӛಔӧ 100 ७Πᡉ༾᜔ᢀჸǶ(1)A9 ೌࡕ႖Вႝଞڈᐟಔ(2) B7 ೌࡕ 8 Вႝଞڈᐟಔ (3)C3 ೌࡕ 15 ВႝଞڈᐟಔǴӧ 100 X ᡉ༾᜔ᢀჸΠว౜ӆғޑՈ ᆅ(εጂᓐೀ)ӧ B ಔԖܴᡉ࣬ჹܭ A ಔԖܴᡉޑቚуޑ౜ຝǶ(scale bar =100 µm)

A9-400X

B7-400X BV

BV MA

C3-400X

კ 4.13 Ӛಔӧ 400 ७Πᡉ༾᜔ᢀჸǶ(1)A9 ೌࡕ႖Вႝଞڈᐟಔ(2) B7 ೌࡕ 8 Вႝଞڈᐟಔ (3)C3 ೌࡕ 15 ВႝଞڈᐟಔǴว౜ઓ࿶ϣጢϣ೿Ԗڀᡎᓋޑઓ࿶ᠼ ᆢϷՈᆅ฻ǶB ಔ֖ઓ࿶ᠼᆢޑᡎᓋၨλЪၨஏ໣ǴᡎᓋᕉനࠆϷֹ᏾ǴϿԖޜݰǹ Aಔ֖ઓ࿶ᠼᆢޑᡎᓋၨεک᚞ණǴᡎᓋᕉၨᖓϷόֹ᏾ǴޜݰΨКၨӭǶ(scale bar

=30 µm)

4.4 ӆғઓ࿶ಔᙃᏢۓໆϩ݋่݀

ಔᙃᏢۓໆϩ݋Ьाхࡴຑ՗ӆғઓ࿶ޑӄ೽य़ᑈǵઓ࿶ϣጢय़ ᑈǵઓ࿶ືँኧҞǵઓ࿶ືँѳ֡य़ᑈǵઓ࿶ືँஏࡋǵઓ࿶ືँय़ᑈ ԭϩКǵӆғՈᆅϐኧҞǵᕴय़ᑈϷѳ֡य़ᑈǴӆғՈᆅय़ᑈԭϩК฻

֡ճҔறՅቹႽϩ݋س಍բ΋سӈ಍ीϩ݋Ǵ่݀ӵ߄ 4.8Ƕ

BV MA

߄ 4.8 ӆғઓ࿶ಔᙃᏢۓໆኧᏵ߄

Perecentage of total axon area in Endo.area

C5 N/A

4.4.1 ӆғઓ࿶ޑӄ೽य़ᑈ(Total Area)

КၨӚಔӆғઓ࿶ϐӄ೽य़ᑈǴว౜ೌࡕ 15 Вႝଞڈᐟಔ > ೌࡕ 8 В

಍ीБݤǺone-way ANOVAǹ٣ࡕᔠۓǺTukey HSD

Total Area (mm2)

4.4.2 ӆғઓ࿶ϣጢय़ᑈ(Endo. Area)

КၨӚಔϐӆғઓ࿶ϣጢय़ᑈǴว౜ೌࡕ 15 Вႝଞڈᐟಔ > ೌࡕ 8 Вႝଞڈᐟಔ > ೌࡕ႖ВႝଞڈᐟಔǴՠࣣ҂ၲ಍ी΢ᡉ๱ৡ౦(߄ 4.10Ǵკ 4.15)Ƕ

߄ 4.10 Ӛಔӆғઓ࿶ϣጢय़ᑈϐ่݀ᆶ಍ी

ಔձ ӆғઓ࿶ϣጢय़ᑈ (mm²) Fॶ Pॶ ٣ࡕᔠۓ Aಔ

ೌࡕ႖Вႝଞڈᐟ 0.129 ± 0.007 Bಔ

ೌࡕ 8 Вႝଞڈᐟ 0.170 ± 0.042 Cಔ

ೌࡕ 15 Вႝଞڈᐟ 0.190 ± 0.064

1.598 0.246 คᡉ๱

Endo.Area(mm2)

˃ˁ˃ˈ

˃ˁ˄

˃ˁ˄ˈ

˃ˁ˅

˃ˁ˅ˈ

˃ˁˆ

˔ ˕ ˖

კ 4.15 Ӛಔӆғઓ࿶ϣጢय़ᑈࢊރკ

4.4.3 ઓ࿶ືँኧҞ(Axon number) ϷՈᆅኧҞ(߄ 4.11)

КၨӚಔϐઓ࿶ືँኧҞǴว౜ B ಔޑѳ֡ઓ࿶ືँኧҞ࣬ჹܭ A ಔӭǴԶ C ಔޑѳ֡ઓ࿶ືँኧҞҭ࣬ჹܭ A ಔӭǴၲ಍ी΢ᡉ๱ৡ౦ (߄ 4.12Ǵკ 4.16)Ƕ

КၨӚಔϐཥғՈᆅኧҞǴว౜ B ಔޑѳ֡ཥғՈᆅኧҞ࣬ჹܭ A ಔӭǴၲ಍ी΢ᡉ๱ৡ౦(߄ 4.13Ǵკ 4.17)Ƕ

߄ 4.11 Ӛಔӆғઓ࿶ືँᆶཥғՈᆅኧҞ

Axon number(#)

˄˃˃˃

˅˃˃˃

ˆ˃˃˃

ˇ˃˃˃

ˈ˃˃˃

˔ ˕ ˖

C5 N/A C6 N/A C7 N/A C8 2590 33 C9 4309 75 C10 N/A

Mean±S.D. 3556±758^ϩ 41±24

ɀ A vs B, p < 0.05 ɉ A vs C, p < 0.05

߄ 4.12 Ӛಔӆғઓ࿶ືँኧҞ಍ीϩ݋

ಔձ ઓ࿶ືँኧҞ(#) F ॶ Pॶ ٣ࡕᔠۓ Aಔ

ೌࡕ႖Вႝଞڈᐟ 1510± 1111^*ϩ Bಔ

ೌࡕ 8 Вႝଞڈᐟ 3222± 1161^* Cಔ

ೌࡕ 15 Вႝଞڈᐟ 3556±758^ϩ

3.677 0.06

Bಔ>A ಔ Cಔ>A ಔ

კ 4.16 Ӛಔӆғઓ࿶ືँኧҞࢊރკ

B.V. Number(#)

4.4.4 ઓ࿶ືँѳ֡य़ᑈ(Mean axon area)

КၨӚಔϐઓ࿶ືँѳ֡य़ᑈǴว౜ A ಔ>B ಔ>C ಔǶՠࣣ҂ၲ಍

Mean axon area(um2)

4.4.5 ઓ࿶ືँஏࡋ(axon density)

КၨӚಔϐઓ࿶ືँஏࡋǴว౜ C ಔౣεܭ B ಔǴB ಔϷ C ಔεܭ

ೌࡕ႖Вႝଞڈᐟ 11468.94±8335.69 Bಔ

ೌࡕ 8 Вႝଞڈᐟ 18940.34±6658.03 Cಔ

ೌࡕ 15 Вႝଞڈᐟ 19314.33±3569.32

1.697 0.228 คᡉ๱

4.4.6 ઓ࿶ືँय़ᑈԭϩК

(Perecentage of total axon Area in Endo. Area)

КၨӚಔϐઓ࿶ືँय़ᑈԭϩКǴว౜ B ಔᆶ C ಔ࣬߈ǴB ಔϷ C ಔ֡εܭ A ಔǴՠࣣ҂ၲ಍ी΢ᡉ๱ৡ౦ (߄ 4.16Ǵკ 4.20)Ƕ

߄ 4.16 Ӛಔӆғઓ࿶ືँय़ᑈԭϩК಍ीϩ݋

ಔձ

ઓ࿶ືँय़ᑈԭϩК

(Perecentage of total axon Area in Endo. Area)%

Perecentage of total axon area in Endo.area(%)

4.4.7 ӆғՈᆅᕴय़ᑈ(B.V. area)

КၨӚಔϐӆғՈᆅᕴय़ᑈǴว౜ C ಔ>A ಔ>B ಔǴԶ B ಔϷ C ಔ໔ৡ౦ၨεǴᆕӝٰᇥ C ಔޑӆғՈᆅᕴय़ᑈനεǴՠࣣ҂ၲ಍ी΢

ᡉ๱ৡ౦ (߄ 4.17Ǵკ 4.21)Ƕ

߄ 4.17 ӚಔӆғՈᆅᕴय़ᑈ಍ीϩ݋

ೌࡕ 15 Вႝଞڈᐟ 187.439±140.302

2.201 0.157 คᡉ๱

(Perecentage of total B. V. in nerve Area)

КၨӚಔϐӆғՈᆅय़ᑈԭϩКǴว౜ C ಔ>B ಔ>A ಔǴԶ A ಔ Ϸ C ಔ໔ৡ౦ၨεǴՠࣣ҂ၲ಍ी΢ᡉ๱ৡ౦Ƕ(߄ 4.18Ǵკ 4.22)Ƕ

߄ 4.18 ӚಔӆғՈᆅय़ᑈԭϩК಍ीϩ݋

ಔձ

ӆғՈᆅय़ᑈԭϩК (Perecentage of total B. V. in

nerve Area)%

Fॶ Pॶ ٣ࡕᔠۓ

Aಔ

ೌࡕ႖Вႝଞڈᐟ 1.414±0.634 0.958 0.413 คᡉ๱

Bಔ

ೌࡕ 8 Вႝଞڈᐟ 2.313±1.602 Cಔ

ೌࡕ 15 Вႝଞڈᐟ 2.814±1.032

Perecentage of total B.V. in nerve Area(и)

˅ ˆ ˇ ˈ

˔ ˕ ˖

კ 4.22 ӚಔӆғՈᆅय़ᑈԭϩКࢊރკ

4.5 ႝғ౛ᔠෳϩ݋่݀

4.5.1 ႝғ౛ᔠෳ

1. ݢ׎ж߄ཀက(კ 4.23)

კ 4.23 ႝғ౛ᔠෳݢ׎ж߄ཀက

Θઓ࿶໺Ꮴೲࡋɡჹڬᜐઓ࿶фૈ଺ቶݱຑ՗Ƕ Θਁ൯ɡઓ࿶ᠼᆢኧҞǴ໺Ꮴೲࡋޑ΋ठ܄Ƕ

ݢය

Լᠼᆢౢғࢲ୏ႝՏૈΚǶ ಔձ Latency1(L1)

(ms)

B10 0.95 49.97 4.54 1.14 2.00

L1(ms)

4.5.4 ݢය(Duration)

კ 4.27 Ӛಔႝғ౛ᔠෳݢ׎ਁ൯ࢊރკ

4.5.6 य़ᑈ(Area)

ϩձຑ՗ AǵBǵC Οಔޑႝғ౛ᔠෳݢ׎ϐय़ᑈǴว౜ C ಔ࣬ჹ ܭځᎩӚಔεǴՠࢂࣣ҂ၲ಍ी΢ޑᡉ๱ཀက(߄ 4.24Ǵკ 4.28)Ƕ

߄ 4.24 Ӛಔႝғ౛ᔠෳݢ׎य़ᑈ಍ीϩ݋

ಔձ Area य़ᑈ(mVms) F ॶ Pॶ ٣ࡕᔠۓ Aಔ

ೌࡕ႖Вႝଞڈᐟ 1.89±0.87 Bಔ

ೌࡕ 8 Вႝଞڈᐟ 3.66±1.76 Cಔ

ೌࡕ 15 Вႝଞڈᐟ

5.23±3.41

1.917 0.193 คᡉ๱

Area(mVms)

˅ ˇ ˉ ˋ

˄˃

˔ ˕ ˖

კ 4.28 Ӛಔႝғ౛ᔠෳݢ׎य़ᑈࢊރკ

Amplitude(mV)

˃ ˈ

˄˃

˄ˈ

˔ ˕ ˖

ಃϖക ૸ፕ

5.1 ҁࣴز่݀ϐ௖૸

ҁჴᡍӧ௖૸όӕޑႝଞڈᐟϟΕਔ໔ᗺࢂց཮ቹៜઓ࿶ӆғǴ ᕇள่݀ࣁǺೌࡕҥջ๏ϒႝଞڈᐟ཮׭ڋઓ࿶ޑӆғǴԶೌࡕ 8 Вӆ

๏ϒႝଞڈᐟ཮ڈᐟઓ࿶ӆғǴЪઓ࿶фૈࡠൺၨ٫ǶаΠଞჹόӕ่

݀уа૸ፕǺ

5.1.1 ޖጤᆅᏤᆅೕ਱Ϸႝଞޑ׎Ԅ

ҁჴᡍ܌௦Ҕޑޖጤᆅځߏࡋߏ 12 mmǴϣ৩ࣁ 1.5 mmǴѦ৩ࣁ 2 mmǶӢࣁޖጤᇙઓ࿶ᆅӧΓᡏჴᡍύ٠ό཮ౢғᝄख़ޑ௨ѾբҔ^[16]Ǵ ԶЪڀԖΠӈ੝܄Ǻ

1.ޖጤࢂόё೯೸ޑǴѬૈගٮӆғઓ࿶ൂપғߏޑᕉნǴӢԜ୤

΋ૈቹៜઓ࿶ӆғޑғϯӢηջࢂᆅϣޑಒझǵనᡏکߦ຾ઓ࿶ғߏޑ ނ፦Ƕ

2.ޖጤᆅගٮΑؼӳޑࢎᐏǴ٬ӆғޑઓ࿶ᠼᆢૈරઓ࿶ᇻᘐᆄޑ БӛғߏǶ

3.җܭޖጤޑόё֎ԏ܄Ǵ٬ޖጤᆅૈගٮӆғઓ࿶ᒷೱុޑғߏǶ ӧ Longo ฻^[98]ჴᡍύว౜ճҔޖጤᆅբࣁௗӝޑπڀёаᗉխઓ

࿶ዦޑ׎ԋǴᔅշӆғޑᔼᎦނ፦໺ሀǶ܌аךॺӧҁჴᡍύ௦Ҕޖጤ ᆅբࣁௗӝᏤᆅޑᕉნܴᡉၨࣁᛙۓޑǴёа຾΋؁ᢀჸډόӕᓎ౗ႝ

ଞჹઓ࿶ӆғޑቹៜǶ

ӧҁჴᡍύ܌௦Ҕޑႝଞ׎ԄࢂેፂԄޑޔࢬႝڈᐟǴ൩΋૓த٬

Ҕႝཱུ׎ԄЬाёϩࣁΟᅿǴх֖߄य़ڈᐟǵ෌ΕڈᐟϷऀҜڈᐟ^[243]Ƕ ߄य़ႝཱུதҔٰ٬ҔբݯᕍޑфૈǴՠӢԖڰۓόܰϷѝԖ߄ቫޑԼԺ

཮೏ڈᐟό୼ుΕޑલᗺǴѝҔܭݯᕍၨ߄భޑཞ໾ǹ෌Εႝཱུޑ٬Ҕ ёҔܭుቫޑݯᕍǴՠ೭ಖزࢂ΋ঁѦٰނ፦Ǵᗨฅό཮ଭ΢Ԗઇ຋ޑ ӒᓀǴߏਔ໔߾ёૈԖЇววݹϸᔈϐဤǹԶऀҜڈᐟ࣬ჹܭځдٿޣ КၨӼӄǴёаБߡޑܫӧךॺ܌ाڈᐟޑԼԺ(όፕుభ)ǵाݯᕍޑ ઓ࿶΢܈ࢂҤՏ΢Ǵڈᐟֹ൩ёܘନၨคٳวੱౢғǴ܌аӧᖏ׉ΨК

ၨத೏٬ҔǶ

΋૓٬Ҕႝଞޑགࢉᐒ౗ࡐեǴӧ Bhadra ک Peckham^[243]܌଺ޑࣴ

زύǴၮҔӧຬၸ 2000 Γኧ٬ҔऀҜଞڈڈᐟ࡭ុϖԃǴ่݀ว౜ѝ Ԗ΋ҹԖགࢉǴགࢉᐒ౗ཱུեǴ܌аךॺ٬ҔޑႝଞࡐӼӄǶќ΋ঁॶ ள૸ፕޑୢᚒࢂɡߏΦаٰၮҔႝ൑ܭಔᙃ୻Ꭶύ܈ӧࢲᡏჴᡍύٰ

ЇᏤઓ࿶ғߏǴ೿ࢂ௦Ҕߚதեޑႝࢬமࡋٰߦ຾ઓ࿶ӆғǴεऊ೿ӧ 1.5 µA аΠ[153-154,157,160,244-246]

܈ࢂ 10 µA[152,155,247]

ࣗԿӆଯ΋ᗺޑ 20µA Yannas^[81]܌ኗቪޑPNS regenerationӣ៝܄ЎകύǴдஒ߈20ԃٰޑڬᜐ ઓ࿶ᆅࣴز߃؁኱ྗϯǴЬाࢂᙖҗcritical axon elongationٰஒၗ਑ᙁ ϯ኱ྗϯǴԶcritical axon elongationޑۓက൩ࢂ50%ઓ࿶ӆௗӝ౗ޑ੝ۓ

໔ሜߏࡋǴӧεႵLcࣁ9.7 ± 1.8 mmǶҁჴᡍϐεႵઓ࿶ᆅࣁ10mmǴᆶ Yannas^[93]ϐ่݀࣬ၨךॺว౜ೌࡕ8В๏ϒႝଞڈᐟёගଯઓ࿶ӆғ

౗ǴԶೌࡕҥջ๏ϒႝଞڈᐟ߾ϸԶ཮׭ڋӆғǴϐ߻Ǵ΋૓ᇡࣁԐය

ନԜϐѦǴᗋԖ΋٤࣬ᜢ౛ፕΨ೏ගрǶBorgens฻^[257]ගрᙖҗѦ ӧޑႝ൑ڈᐟǴёа׭ڋϣғ܄ޑႝ൑ǴЪ຾΋؁ёаߥៈືँϣނ፦

ޑ໺ሀߦ຾ઓ࿶ӆғǶLazar฻^[120]ගрႝ൑ёаߦ຾ಒझᡏϣೈқ፦ޑ ӝԋቚуૈໆޑٮ๏Ǵ຾΋؁ߦ຾ઓ࿶ғߏǶMcCaig฻^[170]߾ගрΑႝ

ଞڈᐟߦ຾ઓ࿶ӆғޑኳԄ(კ5.1)Ǵ྽ૻ৲࿶җႝ൑ڈᐟౢғǴ٬ளϯ Ꮲ ނ ፦ ຾ ΋ ؁ ࡰ Ї ғ ߏ ᒷ ᖿ ӛ ഍ ཱུ Ǵ Զ ϯ Ꮲ ނ ፦ ϩ ձ ᆶ Deleted in Colorectal Cancer (DCC)ǵtrkBǵintegrintǵAChRޑௗڙᏔ࣬ᜢǴᙖҗႝ

ଞٰቹៜ້ޑᐚࡋ೷ԋ້ޑቚуǴԶЇଆ້ᐚࡋৡ౦߾ၟ phosphor- inositide-3 kinase (PI-3K)کphospholipase C (PLC) ܌وޑၡ৩࣬ᜢǴЪ࣬

ᜢޑၡ৩Ьाё࿶җΌㄽᖌᡵբҔӧΌㄽᖌᡵௗڙᏔ(AChR) Ǵတ़ғ ઓ࿶෷ᎦӢη(BDNF)բҔӧ trkBௗڙᏔ܈࿶җᐟวnetrin-1ٰፓ௓DCC

ௗڙᏔ܌຾΋؁ЇวPI-3K܈PLCၡ৩Ǵനಖቹៜ້ޑᐚࡋǶќ΋Бय़ႝ

ଞڈᐟΨ཮٬ளlamininϩݜintegrintǴ຾΋؁Ψ཮ቹៜ້ޑᐚࡋ٬ᐚࡋ ቚ у Ƕ Զ ቚ у ޑ ້ ᐚ ࡋ ຾ ΋ ؁ ཮ ග ଯ cAMP ᐚ ࡋ Ǵ ཮ ڈ ᐟ cAMP-dependent protein kinase A (PKA Ǵ the asterisk indicating activation)ǴԶࡕڙډ഍ཱུޑ֎Їߦ຾ઓ࿶ޑӆғǶ

კ 5.1 ႝଞڈᐟߦ຾ઓ࿶ӆғޑኳԄ

а΢ޑ౛ፕΨ೚፾ҔӧှញࣁՖႝଞڈᐟ཮ߦ຾ઓ࿶ӆғޑᐒڋǴ ՠ٠ؒԖᒤݤှញӄ೽౜ຝǴӢࣁΨԖࣴزև౜ႝଞڈᐟࢂ׭ڋޑǴԶ

ႝଞޑϟΕਔ໔ᗺࢂց཮ቹៜӆғǻ܌аሡा຾΋؁ٰ௖૸Ƕ

ႝଞΨёૈ཮Ԗ׭ڋբҔǴаΠᇆ໣ΑԖᜢႝଞ೷ԋઓ࿶׭ڋޑЎ

᝘Ǵٰ຾΋؁଺ϩ݋ǶHanson ک Mcginnis^[191]ӧჴᡍύว౜ႝଞ཮׭ڋ ઓ࿶ӆғޑ่݀Ǵдॺࢂஒ 40 ଫεႵѓୁϐ֤ମઓ࿶ᄒᘐࡕǴа 10 mm ߏϐޖጤᇙઓ࿶ᆅჹᄒᘐϐ֤ମઓ࿶଺΋ௗӝǴჴᡍಔࡼа 10 µA ϐޔ ࢬႝڈᐟ(഍ཱུ࿼ܭޖጤᆅϣ೽ύࢤǴ໚ཱུ߾࿼ܭᇻೀ)ǴԶ௓ڋಔ߾ό

ௗڙҺՖڈᐟǴΟຼࡕว౜܌Ԗ௓ڋಔޑޖጤᆅύ֡Ԗઓ࿶ӆғޑౢ

ғǴԶჴᡍಔ໻ 35%Ԗઓ࿶ӆғǴЪᢀჸډཇௗ߈ႝࢬڈᐟೀϐӆғઓ

࿶ືँኧ൩ཇϿǴ܌аႝཱུޑՏ࿼ࢂቹៜઓ࿶ӆғޑ΋ঁख़ाӢનǶ Mcginnis ک Murphy ฻^[190]ஒϺޞႵޑ๢ମઓ࿶аႄηᓸ໾Ǵܭֽ೽ࡼа

࡭ុ 20 µA ޔࢬႝڈᐟǴ14 Ϻࡕว౜ځဌ೩՜৖ϸ৔(toe spreaing reflex) ڈᐟǵԼԺԏᕭޑወҷයǵઓ࿶ᠼᆢኧҞکஏࡋکჹྣಔКၨ֡คᡉ๱

ཀကǴӕਔҗ่݀௢ፕёૈࢂҗܭႝڈᐟೀϐႝှނಕᑈԶ׭ڋΑઓ࿶

ޑӆғ^[191]ǶAgnew ฻^[258]ࡰрό྽ޑႝଞႝࢬڈᐟǴёૈޔௗ׭ڋΑઓ

࿶ޑӆғǶ܌аࣁϙሶ཮Ԗॄय़ޑਏ݀ګǻЬाёᘜӢ൳ঁচӢǴٯӵ όӕޑڈᐟྍǵ࿼ܫႝཱུՏ࿼ޑόӕϷό҅ዴޑႝଞ٬Ҕ฻Ǵ೿཮೷ԋ

׭ڋઓ࿶ӆғޑ౜ຝǶӧ೚ӭࣴزύࡰр٬Ҕଯᓎ౗ޑႝࢬޔௗڈᐟઓ

࿶཮೷ԋזೲߔᘐઓ࿶໺^[259-269]ǶAgnew ฻[258,270-271]

ࣴزύว౜ଯᓎႝ

ႝଞଯᓎ౗ڈᐟਔǴ߾ځѦޑൎઓ࿶ጢय़ᑈ (connetive capsule area)ᡂε ޑԶӆғઓ࿶༸(nerve trunk diameter)ᕭλޑǶ຾΋؁வ Yannas^[100-101]ޑ ᓸΚ೑౛ፕϷ୷ۭጢ༾ᆅ౛ፕ౛ፕёаளډ᛾ჴǴ྽ӆғಔᙃޑൎઓ࿶

ᆫ໣׎ԋಒझࢊǴ٠ЇᏤືँޑᎂΕǵ౽ՉǵᡎᓋϯΨࢂ،ۓઓ࿶ӆғ ޑख़ाӢનϐ΋Ƕவ Cheng ޑࣴزύளޕᓎ౗ଯਔǴൎઓ࿶ጢय़ᑈᡂε ջᠼᆢ҆ಒझቚуЪӆғઓ࿶༸ᕭλջ೚ܮಒझࢊᡂλǴ܌а൩ளډଯ ᓎ཮׭ڋઓ࿶ӆғޑ่݀Ƕӧҁჴᡍޑ่݀ӧၨߏᄒᘐຯᚆΠǴว౜ᒿ

๱ᓎ౗ቚуӆғઓ࿶ӄ೽य़ᑈϷϣጢय़ᑈᡂλǴЪӧڬൎΨԖᠼᆢ҆ಒ झޑቚӭ಄ӝ಄ӝ Cheng ޑଷ೛Ƕ

܌аᆕӝ܌ॊךॺёаளޕѤঁख़ाޑӢનቹៜҁԛჴᡍޑᐒڋǺ

΋ǵᒿ๱ᓎ౗ޑቚу೷ԋԐයືँޑଏϯཞ໾ቚӭ(ۯߏΑґୌМଏ ϯ)Ǵ຾΋؁ቹៜΑઓ࿶ޑӆғǶ

Βǵᒿ๱ᓎ౗ޑቚу೷ԋᠼᆢ҆ಒझቚуϷ୷ۭጢ೯ၰᡂಒǴ຾΋

؁ቹៜΑઓ࿶ӆғޑၡ৩෧Ͽځԋф౗Ƕ

Οǵёૈᓎ౗ޑቚуǴ٬ޑႇ܈້ᚆη೯ၰׯᡂǴ຾΋؁೷ԋಒझ ጢႝՏόᛙۓǴߔᘐઓ࿶໺Ꮴ׭ڋӆғǶ

Ѥǵଯᓎႝଞ཮٬ளᙔМ่਒ϩݜၸӭޑ਻ݰ܈ႝှނǴ຾΋؁ߔ ᘐ୷ۭቫύືँ፦ޑࢬ୏Զ׭ڋғߏǶ

ᆕӝ΢ॊёޕǴ້ᚆηᐚࡋׯᡂࢂᓎ౗ቹៜઓ࿶ӆғޑ΋ঁࡐख़ा

ޑӢનǶ྽եᓎਔǴӢࣁอኩቚуޑ້ᚆη཮ۯ጗ΑಔᙃޑଏϯϷวݹ ϸᔈНဍޑౢғǴԶЪёа፾྽ளѳᑽڙ໾ΑಒझጢႝՏ෧጗ଏϯǴ׳

຾΋؁ёаౢғߦ຾ઓ࿶ӆғޑނ፦Ǵ࿶җᇻᆄ഍ཱུޑ֎ЇԶߦ຾ӆ ғǶ࣬ჹޑӵ݀ᓎ౗ቚуਔǴёૈ཮࡭ុቹៜ້ᚆη܈ႇᚆη೯ၰԶ่

݀ࠅࢂ໾্Αືँ೷ԋືँଏϯǴЪ٬ளጢႝՏߏයೀܭၸࡋѐཱུϯᐟ ว܈ࢂӆཱུϯᓉЗ౜ຝࣣ೷ԋคݤ໺ሀૻ৲Ǵ຾Զ׭ڋΑઓ࿶ޑӆғǴ Զ೭ঁ௢ፕёૈሡाԖ׳ӭޑࣴزٰ่݀Ѝ࡭Ƕ

ҁჴᡍޑख़ᗺࢂ๏ϒ࣬ӕႝଞڈᐟ(1mAǴ2Hz)Ǵӧόӕޑਔ໔ᗺ(ೌ

ࡕ႖Вǵೌࡕ 8 ВϷೌࡕ 15 В)ϟΕႝଞڈᐟǴᢀჸႝଞڈᐟϟΕਔ໔ ᗺჹઓ࿶ӆғޑቹៜǴᒧҔႝଞڈᐟኳԄਔǴᒧ᏷Αჹઓ࿶ӆғ࣬ჹԖ շ੻ޑኳԄ—եᓎեᏊໆǴஒᢀჸख़ЈᘍӧϟΕਔ໔ᗺǶ

Kozolowski ฻^[196] , 1996ǹHumm ฻^[197], 1998ǹDeBow ฻^[198],2008

ࣴزύᡉҢǴόፕࢂӧᖏ׉܈ࢂ୏ނჴᡍБय़ǴՖਔࢂന࡞྽ޑൺ଼ݯ ᕍϟΕਔᐒࣣۘ҂ܴਟǴёૈᆶڙཞރݩԖᜢǶԶ Alaverdashvili ฻^[199],

2008 ᇡࣁό፾྽ޑൺ଼ำׇҭёૈቹៜႣࡕǴٯӵᏢ཮όؼ٬ҔǶӧ Griesbach ฻^[200],2007 ޑჴᡍύගрઓ࿶ڙཞࡕٿࢃයӆ๏ϒ૽ግݯᕍ Кҥջ๏ϒݯᕍ׳ૈቚу BDNF ޑ߄౜Ϸߦ຾фૈࡠൺǴჴᡍว౜ೌࡕ 7-14 Ϻӆ๏ϒ૽ግಔޑ BDNF ቚуໆ࣬ၨܭೌࡕҥջ๏ϒ૽ግ 6 Ϻಔ ଯǶԶа FPI εႵࣁჴᡍኳԄύǴว౜ԾЬ܄ൺ଼ݯᕍޑԋਏ཮Ӣڙཞ ำࡋԶ౦Ǵӧᇸࡋ FPI εႵࡼϒҥջາ፺૽ግ٠ό཮٬ၮ୏Їวޑ BDNF ቚуǴϸԶࢂӧೌࡕ 14-20 Ϻࡼϒາ፺૽ግǴੇଭ଑ޑ BDNF ཮ ᒿၮ୏ໆቚуԶԋКٯቚуǴεႵ FPI ҥջ๏ϒາ፺૽ግ٠ό཮٬

BDNF ቚуǴೌࡕ 0-6 Ϻ๏ϒ૽ግϸԶ཮Ꮴठ CREB ک synapsio̹ޑΠ फ़Ǵύࡋ FPI εႵӧ PID30-36 Ϻ๏ϒາ፺ၮ୏ݯᕍǴځ BDNFǵCREB ک synapsio̹֡཮΢ϲǶHumm ฻^[197],(1998)ǹDeBow ฻^[198],(2008)ǹRisedal

฻^[201],(1999)ჴᡍࣣගϷၸԐ๏ϒݯᕍϸԶ཮ቚуઓ࿶ڙཞำࡋǶӧ

ᡎཞ໾εႵࣁჴᡍኳԄǴӧೌࡕ 12 Ϻӆ๏ϒൺ଼૽ግǴว౜ۯࡕ๏ϒ

૽ግ٠όቹៜҜ፦კႽׯᡂǴԶڙၸ૽ግϐεႵځҜ፦ཞ໾ำࡋၨλǶ Humm JL ฻^[197],(1998)ޑჴᡍаൂୁεတڙཞεႵࣁჴᡍኳԄǴஒ҅த

ୁ߻ަڰۓǴ٬εႵၸࡋ٬ҔѨҔޑ஻ୁ߻ަǴว౜ऩၸࡋ٬Ҕ஻ަޑ ރݩวғӧೌࡕ 7 ϺϣǴ߾཮Ꮴठઓ࿶ཞ໾ቚуǴ٠ቹៜځфૈࡠൺǴ ӵ݀วғӧೌࡕಃΒຼǴ߾ό཮Ꮴठઓ࿶ཞ໾уቃǴՠϝ཮ቹៜфૈࡠ ൺǶ

ႝଞڈᐟکၮ୏Ԗᜪ՟ޑբҔᐒᙯǴࣣᆶቚу BDNF ϷځௗڙᏔ trkB ޑ߄౜ԖᜢǴҁჴᡍ่݀ᆶ΢ॊਔ໔ᗺ࣬ᜢჴᡍ่݀όᒉԶӝǴᡉ ҢݯᕍϟΕਔ໔ᗺޑዴ཮ቹៜઓ࿶ӆғ౗Ǵ྽ઓ࿶ڙཞࣁε໔ᘐਔǴۯ ࡕ๏ϒႝଞڈᐟКҥջ๏ϒႝଞڈᐟ׳ૈߦ຾ઓ࿶ӆғǶၸԐϟΕϸԶ

཮׭ڋઓ࿶ӆғǴ፾྽ޑҶ৲ࡕӆϟΕݯᕍǴ཮٬ઓ࿶ӆғঅൺޑރݩ

ၨ٫Ƕ

5.1.3 Ѧӧᢀෳᆶຑ՗่݀૸ፕ

εႵϐѓ֤ମઓ࿶ᎁᄒᘐ٠࿶Ꮴᆅௗӝٿઓ࿶ᘐᆄࡕǴεႵѓࡕަ

Ԗܴᡉޑᡛᅯ౜ຝǴځ؁ᄊόᛙǴܦԕѓࡕަԶՉǴԜੱރ࡭ុวғԿ ჴᡍࡕයǶёૈচӢࣁჴᡍ߃ය֤ମઓ࿶ᎁᄒᘐࡕǴઓ࿶ག໺ѨਏǴค ݤ௓ڋ܌ЍଛޑԼԺ୏բǴࡺևᡛᅯ౜ຝǶԶჴᡍࡕයёૈࢂӆғઓ࿶

ᗨςԋфௗӝٿઓ࿶ᘐᆄǴՠځфૈۘ҂ֹӄࡠൺǴ܈Ӣىࡕၟޑαဍ

๞ੵภǴठ٬εқႵܦԕѓࡕަόؼܭՉǶჴᡍύεႵЋೌࡕޑ໾αǴ ࡠൺ௃׎εठؼӳǴЪؒԖܴᡉޑགࢉวғǶ

5.1.4 ӆғઓ࿶ಔᙃᏢۓ܄Ϸۓໆϩ݋่݀૸ፕ

൩ҁჴᡍӆғઓ࿶ӄ೽य़ᑈԶقǴךॺว౜ӧόӕਔ໔ᗺϟΕႝଞ ڈᐟჹӆғઓ࿶ӄ೽य़ᑈԖቹៜǴၸԐϟΕ཮׭ڋઓ࿶ғߏǴA ಔೌࡕ ႖ВႝଞڈᐟϐεႵޑӆғઓ࿶य़ᑈ࣬ჹၨ B ಔೌࡕ 8 ВႝଞڈᐟϷ C ಔೌࡕ 15 ВႝଞڈᐟλǴՠ٠ค಍ी΢ᡉ๱ཀကǶךॺᇆ໣Α΋٤࣬

ᜢЎ᝘ǶDanielsen ฻^[78]ޑࣴزύගډǴೌࡕ 28 Ϻӆғઓ࿶ᄒय़ᑈ೴ᅌ ᡂλǴЪว౜ԋዕޑӆғઓ࿶Кଆόԋዕޑӆғઓ࿶Ԗၨλޑᄒय़ᑈǶ Lundborg ฻^[276]ҭගр྽ઓ࿶ӆғၲ΋ۓำࡋਔǴځӆғઓ࿶ᄒय़ᑈ཮

җε೴ᅌᡂλǴ٬ளઓ࿶ϣઓ࿶ಒझஏࡋቚуǶଭ฻^[277]ගрઓ࿶ཞ໾

ࡕǴSchwann ಒझࡐז຾ՉԖํϩ຋Ǵ׎ԋҗ୷ۭጢхᇗޑೱុ Schwann ಒझࢊǴSchwann ಒझࢊӧືँӆғਔתᄽЇᏤϷᔼᎦЍ࡭բҔǴ Schwann ಒझࢊ࿶ၸ΋ࢤਔ໔Ǵ཮ӢጤচޑԏᕭԶफ़Կচޔ৩ 10~20%Ǵ Schwann ಒझࢊޔ৩ޑ෧λӧઓ࿶ᘐ໾ࡕΟঁДϣനᡉ๱Ǵ೭΋ၸำࢂ

ё଍ޑǴӆғޑືँё٬ઓ࿶ᄒय़ӆᡂεǶCheng ฻^[177]ჴᡍว౜٬Ҕ 50 Hzǵ100 Hzǵ200 Hz ଯᓎ౗ႝଞځӆғઓ࿶ᕴय़ᑈ(ջӆғઓ࿶״य़ ᑈу΢่ጌಔᙃ៶य़ᑈ)࣬ჹܭൂપଞڈಔϷόࡼҺՖڈᐟޑჹྣ௓ڋ ಔԖᡉ๱ޑ෧λǴдॺගрёૈޑচӢԖΒǺ΋ࢂӢࣁઓ࿶ϣጢय़ᑈ (Schwwann colume)ޑ෧λǹΒࢂёૈᒿ๱ႝଞᓎ౗ቚуߦ٬ᠼᆢ҆ಒझ ޑԏᕭ܈ቚӭǴ຾ԶᓸᕭΑӆғઓ࿶ޑय़ᑈǶᆕӝ΢ॊǴҁჴᡍ܌ᢀჸ ډޑӆғઓ࿶य़ᑈᡂλЬाচӢࢂӢࣁӆғޑઓ࿶ၨࣁԋዕЪёૈӢ ࣁጤচ܈ᠼᆢ҆ಒझޑԏᕭ೷ԋय़ᑈᕭλǶ

൩ҁჴᡍӆғϣጢय़ᑈԶقǴ߾ӕܭӆғޑӄ೽य़ᑈ่݀Ǵӧόӕ ਔ໔ᗺϟΕႝଞڈᐟჹӆғઓ࿶ӄ೽य़ᑈԖቹៜǴၸԐϟΕ཮׭ڋઓ࿶

ғߏǴՠ٠ค಍ी΢ᡉ๱ཀကǶךॺᇆ໣Α΋٤࣬ᜢЎ᝘ǶKerns ک Lucchinetti^[150]ว౜ႝଞ཮٬ӆғϣጢय़ᑈᡂλԶቚуືँޑஏࡋǴӢࣁ дॺᇡࣁႝଞёаቚуϣጢϣనᡏࢬ୏ޑೲ౗Զ෧጗ᇻᆄಔᙃНဍޑ

ᡉ๱ৡ౦ǶHumm ฻^[197],(1998)ǹRisedal ฻^[201],(1999)ǹDeBow ฻^[198],(2008) ჴᡍࣣගϷၸԐ๏ϒݯᕍϸԶ཮ቚуઓ࿶ڙཞำࡋǶ Griesbach ฻

[200]

Ժޑԏᕭ຾΋؁ߦ຾Ոᆅޑཥғٰٮᔈ܌ሡޑԼԺޑᔼᎦǶԼԺԏᕭ཮

೷ԋֽ೽Ոన୏ΚᏢޑׯᡂǴ߾ёૈᆶيᡏϸ৔ψ(somatic/ automic reflex arc)ԖᜢǴϸ৔ψ໺Ε೽ϩࢂҗೱௗԿମᓝԼޑ Group III ک IV ໺

ǶRotto ک Kaufman ฻^[286]

߾ᇡࣁԼԺԏᕭ೷ԋֽ೽Ոన୏ΚᏢׯᡂޑᐒڋёૈᆶԼԺԏᕭਔౢ

ғޑжᖴނ୴ᑈԖᜢǴٯӵ phosphateǵlactateǵlactic acidǵadenosineǵ arachidonicacid ฻Ƕ܌а྽ႝଞᓎ౗ຫଯڈᐟຫமǴԼԺԏᕭຫᓎᕷ܌

๏ЬाٰԾڬᜐ҅தޑՈᆅޑٮ๏Ǵ܌а྽ᓎ౗ຬၸ΋ۓࣚज़ǴϸԶӢ ࣁԼԺԏᕭቚуᔒᓸ҅தՈᆅޑՈనٮ๏຾Զ׭ڋӆғՈᆅኧޑቚғǶ ҁჴᡍ௦ҔޑኳԄࢂեமࡋեᓎ(1mAǵ2Hz)ႝଞڈᐟǴ٩΢ॊ࣬ᜢ

ࣴزǴᡉҢ೭ኬޑႝଞڈᐟኳԄჹઓ࿶ӆғՈൻޑٮᔈࢂԖճޑǴԶ่

݀ᡉҢೌࡕ႖ВႝଞಔޑཥғՈᆅኧҞܴᡉၨೌࡕ 8 ВႝଞಔϿǴё௢

ෳၸԐϟΕႝଞڈᐟ཮ቹៜཥғՈᆅޑӆғǴHumm ฻^[197],(1998)ǹ Risedal฻^[201],(1999)ǹDeBow ฻^[198],(2008)ჴᡍࣣගϷၸԐ๏ϒݯᕍϸԶ

཮ቚуઓ࿶ڙཞำࡋǶ

5.1.5 ႝғ౛ᔠෳϩ݋่݀૸ፕ

൩ҁჴᡍႝғ౛ᔠෳወҷය Latency 1 ԶقǴջࣁइᒵڈᐟԿ໒ۈ ϸᔈ܌ሡϐਔ໔Ǵ่݀ว౜ೌࡕ 8 Вႝଞಔޑወҷය L 1 ࣬ჹܭځдӚ ಔ܌ሡਔ໔ၨอЪ಍ी΢ԖཀကǴ߾ઓ࿶ϸᔈၨזԶࢂόࢂ຾΋؁ж߄ ઓ࿶ࡠൺၨӳ߾ሡ຾΋؁ࣴزǶ Kniffki ฻^[292]මගډ latency ޑ୏բႝ

Տၟӆғઓ࿶ޑԋዕำࡋԖᜢǶ

൩ҁჴᡍႝғ౛ᔠෳݢයԶقǴջࣁइᒵݢ໒ۈᡂϯډࡠൺԿ୷ጕ

܌ሡाϐਔ໔ǴЬा࣮όӕઓ࿶ᠼᆢޑ࣬ჹೲ౗ǴӚಔค಍ी΢ᡉ๱ৡ ౦Ƕӧ Clemente ฻^[293]ჴᡍύว౜྽ޖጤᆅϣӆғઓ࿶຾ՉௗӝਔǴٰ

Ծ΋ᆄޑག᝺ઓ࿶ᠼᆢᆶٰԾќ΋ᆄޑၮ୏ઓ࿶ᠼᆢΨ཮࣬ௗӝǴ٬ள ӆғઓ࿶фૈ໺Ꮴష໶Ǵ೷ԋႝғ౛ෳໆޑ่݀Ǵคݤගٮӆғઓ࿶໺

Ꮴ܈фૈࡠൺޑ҅ዴૻ৲Ƕ܌аךॺёа௢ෳӧόӕਔ໔ᗺ๏ϒႝଞڈ ᐟǴࢂόࢂ཮ቹៜόӕઓ࿶ௗӝਔวғᒱᇤޑᐒ཮Ǵਔ໔ᗺ҅ዴࢂց཮

ЇᏤ҅ዴޑઓ࿶ௗӝ(ག᝺ઓ࿶ௗག᝺ઓ࿶Ǵၮ୏ઓ࿶ௗၮ୏ઓ࿶)Զ٬

ઓ࿶фૈࡠൺؼӳǶ

൩ҁჴᡍႝғ౛ᔠෳਁ൯ԶقǴջࣁइᒵനଯݢঢ়ᆶനեݢঢ়ϐຯ ᚆЬाࢂᢀჸઓ࿶ᠼᆢኧҞǴ໺Ꮴೲࡋޑ΋ठ܄ǴԼᠼᆢౢғࢲ୏ႝՏ

ૈΚǶҁჴᡍӚಔค಍ी΢ᡉ๱ৡ౦ǶԖ่݀ว౜྽ਁ൯ຫεݢයຫอ

ૈߦ຾ઓ࿶ӆғ^[274]Ǵ

൩ҁჴᡍႝғ౛ᔠෳय़ᑈԶقǴջࣁइᒵਁ൯کݢයޑᕴکǴ׳ᆒ ዴᡉҢઓ࿶ᠼᆢኧҞǶ่݀ว౜ೌࡕٿຼႝଞڈᐟಔ࣬ჹܭځᎩӚಔޑ य़ᑈനεǴՠค಍ी΢ᡉ๱ৡ౦Ǵࢂցёаж߄ୖᆶԏᕭޑԼᠼᆢኧҞ

നӭӆғઓ࿶ࡠൺ܄നӳǴϝ໪׳ӭޑࣴزٰ᛾ჴǶ Widick฻^[294]ࡰр྽ઓ࿶ೀܭӆғය໔ਔǴԼԺऩௗڙ࡭ុޑڈᐟёаၲ

ډၨᛙۓޑઓ࿶ႝғ౛ᔠෳǶBrushart฻^[172]٬Ҕ20 Hzႝଞڈᐟёаߦ຾

ၮ୏ઓ࿶ϡޑӆғǴ࿶җӕϯᇻᆄᘐᆄઓ࿶ޑғߏ΋ठ܄ٰߦ຾ӆғǶ ՠࢂԜࣴزύว౜ႝଞࢂёаӧڙ໾ਔӃӕ؁ϯᇻᆄၮ୏ઓ࿶΋ठ܄

຾Զߦ຾ځӆғǴՠࢂ٠ό཮ቚуځӆғޑೲࡋǶBowmanکMcNeal฻

[295]

ว౜྽ڈᐟᓎ౗ӧ100 Hzډ10k Hz໔ਔǴၨଯޑᓎ౗཮ቹៜઓ࿶ޑ໺

ᏤǶBhadra฻^[296]ࣴزύว౜٬Ҕଯᓎ౗ޑႝࢬڈᐟ཮ߔᘐথ٢୏ނڬᜐ ၮ୏ઓ࿶ޑ໺ᏤǴ຾Զ೷ԋઓ࿶ޑߔᘐǶMima฻^[297]ࣴزύӵ݀ӧΖՏ

଼நت܄ௗڙอਔ໔ଯᓎ౗90 HzޑऀҜҤՏႝଞڈᐟǴ่݀ว౜ଯᓎ

ႝଞڈᐟ཮फ़եၮ୏фૈޑᐟวႝՏ(motor evoked potentials)Ъ཮ቚу ག᝺ઓ࿶ޑᐟวሚॶ(sensory threshold)Ǵӕਔ೷ԋག᝺ઓ࿶Ϸၮ୏ઓ࿶

౛ᔠෳၸำӄำ௦਻ഞǴԶഞᎈҭёૈࢂᏤठႝғ౛ᔠෳ่݀ৡ౦εޑ চӢϐ΃Ƕҁჴᡍޑख़Јࣁᢀჸઓ࿶ӆғރݩǴ٩ҁჴᡍ࠻ኳԄϤࢃය ޑઓ࿶ௗӝ౗ς࿶ၸъǴԶԼԺ๺ᕭࡠൺຑ՗ԿϿा฻ 3 ঁДࡕωၨڀ

ཀက^[185]ǴԶႝғ౛ᆶԼԺಔᙃ৲৲࣬ᜢǴЀځࢂႝғ౛ᔠෳय़ᑈᆶୖᆶ

ԼᠼᆢኧҞᜢ߯ஏϪǴ܌аёૈࢂᏤठႝғ౛ෳໆޑ่݀ᆶઓ࿶ϪТ܌

ள่݀คݤ࣬ڥᔈޑচӢǶ

5.1.6 εႵԾූޑ૸ፕ

Ծූ౜ຝջࢂჴᡍ୏ނ֤ମઓ࿶ӆғࡕǴֽ೽ག᝺౦தǴаαࠈى ೩܌ठǶҁჴᡍว౜ӧεႵᄒᘐަԾූБय़Ԗ΋٤ৡ౦ॶள຾΋؁૸

ፕǴӧεႵ֤ମઓ࿶ᄒᘐࡕ൩ഌុԖԾූޑ౜ຝวғǴ೷ԋޑচӢёૈ

ࢂεႵ֤ମઓ࿶ᎁᄒᘐࡕǴى೩Ѩѐག᝺ǴԶ྽ઓ࿶ӆғਔǴى೩ག᝺

ࡠൺՠ᏾ᡏག᝺ϝฅόىǴܭࢂ೷ԋεႵޑԾූՉࣁԶ׎ԋى೩લཞޑ

௃ݩǴԶځࠈ໾ᄒᘐઓ࿶ୁޑى೩཮೷ԋрՈᆶ໾αǴ຾΋؁Ԗ٤ᝄख़

೷ԋى೩ޑᘐ຋ᆶᡂ׎ǶԾූޑวғ౗аೌࡕٿຼ໒ۈႝଞڈᐟಔന ଯǴԾූཞ໾Ψനࣁᝄख़ǴЪຬၸ΋ъޑεႵԖԾූޑ౜ຝǴࣗԿԖى ೩લཞޑ౜ຝǶՠࣁՖؒԖӆғԋф֤ମઓ࿶ϐεႵޑى೩ҭԖࠈ໾Ǵ ԶԖ٤ӆғԋфϐ֤ମઓ࿶ϸԶؒԖԜ౜ຝǴۘሡ຾΋؁ჴᡍωёаှ

ញǶӕਔஒΟಔεႵਥᏵόӕᓎ౗ࢂցڙԾූቹៜճҔ຤ഓᅟᆒዴཷ౗

ᔠۓ(Fisher’s exact test)ٰ଺಍ी΢ޑᔠۓǴว౜ԾූኧҞаఁයϟΕႝ

ଞݯᕍനӭǴՠ٠ค಍ी΢ᡉ๱ཀကǶՠࢂऩࢂ຾΋؁ѐКၨઓ࿶ӆғ ԋф౗ࢂցکԾූԖᜢǴว౜ӧ಍ी΢ؒԖཀကǴ܌аӧҁჴᡍύΨค ݤவ۶Ԝᜢٰ߯ှញԾූޑচӢǶVekris ฻^[298]ว౜Ӣࣁઓ࿶ޑଏϯԶલ Юߥៈޑག᝺Ǵ཮٬ளԾූޑ౜ຝวғǶCarr ฻^[299]Ψว౜ӧόӕεႵ ࠔᅿ໔߾Ծූޑ௃ݩΨԖ܌όӕǶ܌аԾූᆶεႵࠔᅿϷઓ࿶ޑԋዕࡋ

࣬ᜢǴՠࢂόࢂ೿Ӣઓ࿶ཞ໾܌೷ԋ߾ሡ຾΋؁ޑࣴزٰ᛾ܴǶ

5.2 ଞءޑݯᕍਔᐒ

Ѧ໾ࢂࡰҜǵԺǵโǵମཞ໾Ǵёڀᡏϩࣁബ໾ǵମשǵಥՏᆶ໾

โǹϣ໾ࢂࡰҗѦΚ܌Їଆޑ᠌๜ཞ໾Ϸཞ໾ࡕ܌Їଆޑ਻Ոǵ᠌๜ǵ

࿶๎฻่ᄬઇᚯϷфૈધ໶Զр౜ޑӚᅿཞ໾ϣ᛾ǴѬόӕܭϣࣽύ໾

ܭΎ௃܌Їଆޑϣ໾ǶѦ໾کϣ໾Ԗ๱ஏϪޑᜢ߯ǴȸަᡏཞܭѦǴ߾

਻Ո໾ΪϣǴᔼፁԖ܌ࣁೣǴ᠌๜җϐόکȹǶ!

਻ՈǴѦёкᎦҜԺโମǴϣёឲ෸ϖ᠌Ϥ๜ǴྕྦަᡏǴᔶᎦӄ يǴڬࢬၮՉό৲Ǵаᆢ࡭ғڮࢲ୏Ƕ਻ࣁՈࡇǴՈࣁ਻҆Ǵ਻Ո࣬ϕ ٩ߕǴऩ਻่߾ՈᏉǴ਻຀߾Ո຀Ǵ਻ॐ߾ՈوǹϸϐՈᏉ߾਻ᅉǴՈ

຀߾਻຀ǴՈಥ߾਻ΫǶȠનୢ¸ϖ᠌ғԋጇȡࡰрΑȸىڙՈԶૈ؁Ǵ ඓڙՈԶૈඝǴࡰڙՈԶૈឪȹ฻ՈޑфૈǶќѦȠનୢ¸഍໚ᔈຝε ፕȡࡰрȸ਻໾ภǴ׎໾ဍȹǴջဍᆶภࢂ਻Ո໾ࡕޑੰੱ߄౜Ƕӧബ

໾ύё߄౜р໾਻ᆶ໾ՈٿঁБय़Ƕ!!

ύᙴஒନମᓝаѦޑ೬ಔᙃ೿೯ᆀࣁȨโȩǶځჴӭኧޑମ໾೿ӝ ٳԖโ໾ǴҭջѤަک᙮༸೽Տޑ೬ಔᙃཞ໾಍ᆀࣁȨโ໾ȩǴ߫ᆀ߾

ࣁȨ໾โȩǶ٩Ᏽਔ໔ޑߏอǴ໾โΞϩࣁ࡚܄໾โکᄌ܄໾โǶ΋૓

໾ࡕΒڬϣӭ೏ࣚۓࣁ࡚܄໾โǹᄌ܄໾โ΋૓ࡰ࡚܄යѨݯ܈ݯᕍό ᄇۭǴ೷ԋֽ೽ᗦੵ܈ለภǵфૈምᛖǴதᒿമಕϷၶൣࡕуख़Ǵ۳۳ ёϸᙟวբǶ!

΋૓ᖏ׉೬ಔᙃཞ໾ೀ౛চ߾Ǵӧ 35.83 λਔϣځڙཞ೽Տֽ೽༾

ՈᆅϝԖಔᙃనޑᅖрǴֽ೽ϝԖआဍ዗ภϐวݹ߄౜Ǵݯᕍӭ௦Ҕߥ ӺݯᕍǴӵӇኦ܈ࢂ੃ဍۓภϐߎ໳ӵཀණ฻Ǵՠଞءݯᕍޑ೽ҽ߾Ԗ аΠӚᅿኳԄ!

2/ൻ࿶ڗҤǺӧੰՏϐ࿶๎ᒣܴ܌ឦ࿶๎Ǵӆܭ၀࿶ޑ߈ຯᚆ)ֽ

೽*ڗҤϷᇻຯᚆڗҤǶӵǺުภڗުㅴǴဈภڗ๝߲ࢂֽ೽ଛҤǶΞ ӵǺޤ࿶ࠏ჌ڗӈલǴᖌ࿶ୃᓐภڗ໚ᇶǴط࿶ᓐภڗϼؑࢂᇻຯᚆଛ ҤǴԶ࡚܄යᔈᗉխуख़ڈᐟֽ೽ཞ໾೽ՏǴӢԜӭаᇻᆄڗҤݤ຾Չ ݯᕍǶӵ΢Π౧ᏤݤǴڗ౧࿶೯๎ҤǴ܈ЗภҤǶੰѰڗѓǴڗ࣬ჹᔈ Տ࿼ҤՏǶੰ΢ڗΠ܈ੰΠڗ΢Ǵڗ࣬ჹᔈՏ࿼ϐϖᒡҤǴ㨠Ҥǵ๎ҤǶ!

3/!ௗ࿶ڗҤǺ࿶ે΢Π࣬ϕௗೱޑЋىӕӜ࿶ે࣬ௗǴௗ࿶ೀБଛ ҤݤջӃບᘐрឦՖ࿶ޑੰੱǴฅࡕڗځӕୁᆶ΢Π܌ௗޑ࿶ે܈ڗЋ ىӕӜޑ࿶ેǵϖ♟Ҥǵ㨠Ҥǵ๎ҤޑҤՏࡼଞǶٯǺ॥ൣᔸϐٕ࠼࿶

ેǴᖌ࿶ѓୁဈᆲՉ࿄)֤ମઓ࿶ภ*Ǵӵаௗ࿶ೀБଛҤݤڗҤǴᔈڗ Οข࿶ѦᜢҤǴӢΟขௗᖌ࿶Ƕ!

4/!ӕӜ࿶ჹᔈڗҤǺӧݯᕍਔёаڗᆶځ࿶๎Ӝᆀ࣬ӕޑ࿶ેޑ࿶

ҤǶ࿶ેϐ໔ନ߄㚊ᜢ߯ѦǴεӭ಄ӝȸӕ਻࣬؃ȹޑচ߾ǶЋىӕӜ

࿶ӧ੯ੰ໺ᡂکݯᕍբҔ΢ࢂϕ࣬ᜢᖄޑǶаੵภࣁЬޑ੯ੰǴ۳۳ֽ

೽ڗҤόૈ෧ᇸੱރǴԶӧ࣬ᔈޑᇻ႖೽ՏڗҤǴёа٬ੱރ෧ᇸǶӵ

ૅુ೽ੵภёڗ໚ഊࢨ)ىϿ໚ᖌ࿶*܈Ѝྎ)ЋϿ໚Οข࿶*Ƕ!

! ΢ॊଞءݯᕍኳԄǴ֡மፓӧ࡚܄යਔǴόەӧੰ؞ڙཞ೽Տ຾Չ

ᑈཱུݯᕍЋࢤǴаᗉխуख़ֽ೽วݹϸᔈ܈ಔᙃཞ໾ޑวғǶӢԜǴҁ ჴᡍӧᡍ᛾ᖏ׉ݯᕍޑόӕਔයϟΕଞءݯᕍǴ᛾ჴബ໾วғޑ࡚܄ය ໔ၸԐϟΕଞڈݯᕍǴޑዴჹܭઓ࿶฻೬ಔᙃཞ໾ޑಔᙃঅൺ܈фૈࡠ ൺ೷ԋόճቹៜǶ!

5.3 ҂ٰࣴวБӛ

ઓ࿶ᏤᆅௗӝೌၮҔӧઓ࿶ӆғޑሦୱӧҁი໗ոΚΠς࿶ߚத ԋዕǴӧϯᏢБݤޑၮҔБय़ٯӵ nerve growth factorǵbrain-derived neurotrophic factorǵlamininǵfibronectin Ϸ collagen ޑ٬Ҕς࿶Ԗࡐӭࣴ

زԋ݀Ǵՠࢂᖏ׉ӭ௦Ҕނ౛Бݤٰݯᕍ܈ࢂൺ଼Ǵҁࣴز൩ࢂаϐ߻

೚ӭࣴزᓎ౗Ϸႝࢬޑࣴز่݀ࣁ୷ᘵ຾΋؁ளډႝଞڈᐟϟΕਔ໔ ᗺΨࢂቹៜઓ࿶ӆғޑख़ाӢનǶՠࢂ೭ѝၮҔӧεႵᄒᘐ 10 mm ֤ମ ઓ࿶ϐӆғઓ࿶ჴᡍኳࠠޑ߃؁่݀Ǵӵ݀ा຾΋؁ᔈҔӧΓᡏ΢Ǵё

ૈሡा׳ӭኧᏵٰ᛾ܴᕕှǶό໻ࢂൂ࣮ႝଞڈᐟჹઓ࿶ӆғ೷ԋޑቹ ៜǴךॺሡा׳຾΋؁௖૸ځբҔᐒڋࣁՖǵ࣬ᜢಒ༾ޑಔᙃғ౛Ϸੰ

౛ᡂϯǵႝཱུ׷፦ޑᒧ᏷ǵႝࢬமࡋׯᡂޑቹៜǵႝཱུՏ࿼ޑׯᡂǵό ӕނᅿ໔ৡ౦…฻Ǵ҂ٰҁი໗Ψ཮ӧઓ࿶ӆғሦୱΠᝩុոΚǴаځ

ૈࡌҥֹ᏾ޑႝଞૈໆ኱ྗϯϷӼӄϯǴനࡕᔈҔӧᖏ׉΢ёаᔅշઓ

࿶ᘐ໾ޑੰΓ๏ϒᖏ׉ᙴৣЍ࡭Ƕ

ҁჴᡍ௦ҔՏܭ֤ମઓ࿶ཞ໾೽Տ΢ΠӚ΋ҤޑڗҤচ߾Ǵࢂόࢂ

໔ௗёа᛾ܴύᙴ܌ᒏȸ࿶ϐ܌ၸǴੰϐ܌ݯǴȹϷȸჱѨځҤǴЙѨ ځ࿶Ƕȹ฻ڗҤচ߾ࢂ҅ዴޑǴՠѸ໪຾΋؁଺ԖᜢԖᜢ࿶๎౛ፕᆶઓ

࿶౛ፕޑ௖૸ǴӢ܌଺ଞءၮҔӧઓ࿶ᘐ໾ޑࣴزሥϿǴࡌ᝼ӧόӕޑ ઓ࿶ᘐ໾Бय़ٰӭу૸ፕ຾΋؁ࣴزځߦ຾ઓ࿶ӆғޑᐒᙯǶ

ಃϤകʳ ่ፕ

ҁჴᡍว౜ႝଞڈᐟϟΕਔ໔ᗺዴჴቹៜεႵᄒᘐ֤ମઓ࿶ޑઓ࿶

ӆғԋф౗Ǵӧઓ࿶ཞ໾ࡕࡑཞ໾ރݩ࣬ჹᛙۓӆϟΕႝଞڈᐟǴёග ଯઓ࿶ޑӆғԋф౗ǴԶၸԐ๏ϒႝଞڈᐟ߾ϸԶ཮׭ڋઓ࿶ӆғԋф

౗Ƕځύҗઓ࿶ಔᙃϪТύΨӕਔว౜Ǵೌࡕ 8 Вႝଞڈᐟಔځ܌ӆғ ޑઓ࿶ືँኧҞᡉ๱ၨӭǴЪԖ಍ी΢ཀက(p<0.05)ǶԜѦΨว౜ӆғ ՈᆅኧҞӧೌࡕ 8 Вႝଞڈᐟၨೌࡕ႖ВႝଞڈᐟಔࣁӭǴЪӕਔڀԖ

಍ी΢ཀက(p<0.05)Ǵႝғ౛ᔠෳ่݀ΨᆶಔᙃᏢϐᢀჸ่݀࣬಄Ǵೌ

ࡕ 8 Вႝଞڈᐟޑઓ࿶໺Ꮴೲ౗ၨ٫ǴЪڀԖ಍ी΢ޑཀက(p<0.05)Ƕ ᆕᢀ่݀Ǵઓ࿶ཞ໾ࡕගٮ፾྽ҶᎦӆϟΕႝଞڈᐟࢂёаᔅշઓ

࿶ӆғϷઓ࿶фૈࡠൺǴӧઓ࿶ཞ໾ᇸ༾ਔǴႝଞڈᐟޑϟΕਔ໔ᗺჹ ઓ࿶ཞ໾ൺচቹៜၨλǴӢ୏ނڀԖؼӳޑӆғૈΚǴՠࢂӧઓ࿶ཞ໾

ࣁεᄒᘐਔǴၸԐϟΕ߾ϸԶ཮ԖόؼቹៜǴ཮׭ڋઓ࿶ӆғǴ่݀ᡉ ҢڈᐟҁيᆶݯᕍϟΕਔ໔ᗺ֡೷ԋઓ࿶ӆғޑቹៜǶ

ୖԵЎ᝘

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