持续闭式灌洗预防椎板切除后硬膜粘连  

Preventing dura mater adhesion by continuous irrigation after laminectomy

作　　者：王东昕[1] 郑连杰[1] 杨梁[1] 

机构地区：[1]大连医科大学附属第二医院骨科,辽宁大连市116023

出　　处：《中国康复理论与实践》2005年第2期122-124,共3页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的 观察持续闭式灌洗预防椎板切除后硬膜粘连的效果。方法 选成年健康新西兰大白兔 30 只,每只兔的背部做两处切口,分别切除L2 和L6 棘突、椎板,显露硬膜囊,其中一处直接缝合,作为对照组;另一处持续灌洗 72 h,作为冲洗组。术后4周、8周、12周取样行大体和光镜检查,12周样本增加透射电镜检查及计算机图像分析。结果 术后 4 周和 8 周样本见对照组硬膜外腔被大量瘢痕组织填充,直达肌筋膜层,瘢痕与硬膜及周围肌肉组织粘连紧密,难以剥离;冲洗组见硬膜与肌肉之间为膜性物、浸润脂肪或少量瘢痕,与硬膜无粘连或部分粘连,易于钝性分离。术后 12 周样本见对照组硬膜外瘢痕致密而广泛,与硬膜紧密粘连,难以区分;冲洗组硬膜外瘢痕形成少而疏松,与硬膜轻度粘连或无粘连,与对照组存在显著性差异( P <0.05)。透射电镜下见,对照组硬膜外组织为致密瘢痕组织;冲洗组主要为脂肪组织,脂肪细胞间夹杂少量胶原纤维。结论 兔椎板切除后持续生理盐水灌洗72ObjectiveTo observe the effect of continuous irrigation on preventing dura mater adhesion after laminectomy.Methods30 New Zealand rabbits were used as the animal model. Laminectomy was performed in L 2 and L 6 segments of every rabbit respectively through two incisions. One incision was sutured directly, and as the control group. Irrigative pipe was put into the other incision as the irrigation group and continuously irrigating for 72 h. The animals were sacrificed at 4, 8 and 12 weeks postoperatively. The specimens were prepared for macroscopy, light microscopy, electron microscopy and computer image analysis.ResultsAt 12th week, macroscopy and light microscopy showed that in the control group epidural scar was dense and widespread, and adherent to dura tightly, but in irrigation group epidural scar was loose and limited, and adherent to dura scarcely. There was a significant difference between two groups ( P<0.05). Electron microscopy showed that in control group the epidural tissue was mainly dense scar, and in irrigation group it was mainly fat tissue which mixed with a few of collagen fibers.ConclusionThe continuous irrigation has a preventive effect on adhesion of dura mater after laminectomy in rabbit. [

关 键 词：硬膜 粘连 椎板切除术 灌洗 

分 类 号：R619[医药卫生—外科学]