同种异体胎儿颅骨脑脊膜椎管成形在预防椎板切除后硬膜外瘢痕中的临床应用  

Prevention of epidural scar after laminectomy with allogeneic fetal skull meningeal vertebral canaloplasty

作　　者：李涛[1] 陈日景[2] 钟桂午 吴养[1] 吴春辉[1] 李志丹[1] 

机构地区：[1]广东医学院附属湛江中心人民医院骨科,广东湛江524037 [2]广东医学院附属医院骨科 [3]解放军北京空军医院骨科

出　　处：《解剖与临床》2005年第1期45-46,49,共3页Anatomy and Clinics

摘　　要：目的 :探讨深低温同种异体胎儿颅骨脑脊膜椎管成形预防椎板切除后硬膜外瘢痕的效果。方法 :4 4例患者均因腰椎间盘突出合并腰椎管狭窄行腰椎板切除术 ,随机分 4组 ,A组单纯椎板切除 ,B组游离脂肪移植 ,C组充填质量分数为 2 %的透明质酸钠 ,D组用 - 80℃深低温冰箱内保存 4个月的同种异体引产胎儿颅骨脑脊膜置于椎板切除术后的肌肉与硬膜之间。术后进行疗效评分和影像学观察。结果 :随访 6～ 2 4个月 ,参考Macnab评定标准 ,A组优良率 72 .2 % ,B组优良率 80 .9% ,C组优良率 81.8% ,D组优良率 94 .7%。D组与其它组间差异有统计学意义 (P <0 .0 5 )。MRI和CT复查显示 :D组无硬膜外瘢痕粘连 ,其它组有不同程度的硬膜外瘢痕粘连。结论 :用同种异体胎儿颅骨脑脊膜做屏障 。Objective:To investigate the preventive effect of allogeneic fetal skull meningeal vertebral canaloplasty on epidural scar after laminectomy.Methods:44 patients with lumbar disc herniation were randomly divided into four groups:Group A simpily underwent laminectomy;Group B received free-fat transplantation;Group C were placed 2% sodium hyaluronate;Group D were placed allogeneic fetal skull meningeal between the muscle and dural.The meningeal had been placed in -80℃ for 4 months.All the patients were evaluated by the JOA score and performed imaging observation.Results:All the patients were followed up for 6～24 months.According to Macnab score,the excellent and good rate was 72.2% in group A,80.9% in group B,81.8% in group C,94.7% in group D.The prevention effect of group D was significantly better than the others.The MRI and CT scans showed no adhesion between the epidural scar and the dural sac in all patients of D group.There existed adhesion of different degree in other groups.Conclusion:Using allogeneic fetal skull meningeal as a shield can prevent epidural scar better.

关 键 词：同种异体 椎板切除术 硬膜外瘢痕粘连 颅骨 临床应用 胎儿 椎管成形 预防 深低温 术后 

分 类 号：R687.3[医药卫生—骨科学]