持续闭式灌洗及灌洗后给药预防椎板切除后硬膜外瘢痕粘连  

Prevention of epidural adhesion after laminectomy with continuous close irrigati on plus drug administration

作　　者：王东昕[1] 郑连杰[1] 杨梁[1] 

机构地区：[1]大连医科大学第二临床学院骨科,辽宁省大连市116023

出　　处：《中国临床康复》2005年第14期76-79,共4页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:目前的研究表明:粘连是导致下腰椎手术失败的重要原因,并且对粘连造成的手术失败者,其二次手术的效果不佳。因此如何防止下腰椎手术术后粘连,提高脊柱功能,成为困扰临床医师的难题。为此探讨持续闭式灌洗及灌洗后给药对椎板切除后硬膜粘连的预防作用及其效果。方法:实验于2001-08/2002-08在大连医科大学第二临床学院骨科实验室完成。选用成年健康新西兰大白兔30只,采用自身对照,每只兔的背部3处切口,分别切除L1,L4,L7棘突、椎板,显露硬膜囊。其中一处直接缝合,作为对照组。另两处持续灌洗72h后,随机选一处在拔管前注入透明质酸钠与确炎舒松A的合剂作为给药组,剩余的一处作为冲洗组。术后4,8,12周分批取材,4周和8周的标本只行大体和光镜检查;12周的标本行大体、光镜、透射电镜检查及计算机图像分析。光镜检查采用苏木精-伊红(HE)染色和Massion染色。结果:术后4周和8周时大体及光镜检查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;冲洗组和给药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周大体及光镜检查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;冲洗组和给药组硬膜外瘢痕形成少?AIM:As shown in recent research,adhesion is the important cause of unsuccessfu l operation for lower lumbar vertebrae,and the second operation is not satisfact ory due to the adhesion after the first operation.Therefore,it is intractable fo r the clinical physicians to prevent the postoperative adhesion of lower lumbar vertebrae and improve the spinal function.To observe the effect of continuous cl ose irrigation and irrigation associated with drug administration in preventing epidural adhesion after laminectomy. METHODS:The experiment was completed in the laboratory of Department of Orthop aedics in the Second Affiliated Hospital of Dalian Medical University from Augus t 2001 to August 2002.By using self controlled method,30 healthy adult New Zeal and rabbits were performed with laminectomy at spinous process and vertebral lam ina of lumbar 1 segment,lumbar 4 segment and lumbar 7 segment respectively throu gh three incisions to let the dural sac expose.One of the incisions was sutured directly as control group.Irrigative pipes were put into the other two incisions .After 72 hour continuous irrigation,one of the two irrigation incisions receiv ed an injection of 2%sodium hyaluronate and triamcinolone acetonide through the pipe before the pipes were pulled out as administration group,and the other inc ision was left unterated as irrigation group.The animals were sacrificed at 4,8, 12 weeks postoperatively.The specimens were prepared for macroscopy and light mi croscopy at 4 and 8 weeks,and macroscopy,light microscopy,electron microscopy an d computer image analysis at 12 weeks.Hematoxylin and eosin(HE) staining and Mas sion staining were performed during the light microscopy examination. RESULTS:At 4 and 8 weeks,it was found by macroscopy and light microscopy that in the control group a great deal of scar tissues filled in the epidural space t ill the muscular fasciae;scar and dura were adherent onto their surrounding musc le tissues closely,which were hardly to strip;In the irrigation and administrati on group,me

关 键 词：椎板切除术 硬膜 粘连 冲洗法 

分 类 号：R318[医药卫生—生物医学工程]