硬脑膜重建的实验性研究  

An experimental study of duraplasty

作　　者：周峰[1] 林佳平[1] 吴新建[1] 石忠松[1] 夏之柏[1] 黄正松[1] 

机构地区：[1]中山大学附属第一医院神经外科

出　　处：《中国神经精神疾病杂志》2005年第3期172-175,i013,共5页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的探讨自身筋膜硬脑膜重建的愈合机制及碱性成纤维细胞生长因子(bFGF)在其中的应用价值。方法SD大鼠65只分成5组。A组5只,采用自体筋膜硬脑膜重建模型,免疫组化方法观察愈合过程bFGF在其中的表达情况;B组3只,直接将背部筋膜覆盖在硬膜外;C、D、E组各19只,行自体筋膜硬脑膜重建,D组加用外源性bFGF,E组仅用明胶海绵,分别在术后1周、2周通过脑脊液漏研究、组织学及免疫组化法观察外源性bFGF对自体筋膜重建硬脑膜愈合过程的影响并用RTPCR方法研究内源性bFGFmRNA的表达情况。结果自体筋膜移植硬脑膜部位bFGF表达明显;术后1周D组大鼠重建硬脑膜抵抗脑脊液漏压力值明显好于其他组(P<0.05);术后1周移植筋膜的胶原纤维呈粗大、杂乱的表现而术后2周胶原纤维的排列比较规则,经历了“再塑性”的过程;内源性bFGFmRNA的表达没有明显变化。结论成纤维细胞的浸润、新生血管生成及胶原纤维的合成是自体筋膜重建硬脑膜愈合过程的重要机制;在此过程中bFGF可能起了重要的作用;外源性bFGF处理的大鼠其移植筋膜愈合要好于对照组。Objective To study the mechanism of healing process of duraplasty achieved using a free fascial graft and the effect of basic fibroblast growth factor on it. Methods The dural reconstruction models were created in 5 rats of group A, but in the 3 rats of Group B a piece of fascia was put outside the intact dura mater. The effect of growth factors on it was studied by immunohistochemical method. In group C, D and E, 19 rats in each group, dural reconstruction models were made and exogenous bFGF was administered in group D but only gelfoam was given in group E. The influence of exogenous bFGF on it was studied by CSF leak experiment, histological and immunohistochemical methods after 1 or 2 weeks. The expression of endogenous bFGF was studied by RT-PCR. Results The reconstructed dura was immunohistochemical stained with antibodies against bFGF. There is statistical difference between group D and the other two groups in the pressures against CSF leak 1 week after operation (P<0.05). The collagen fibers were coarse and disorganized 1 week after sugery, but 2 weeks ofter operation the collagen fibers were regularly arranged. There is no difference among the three groups in the expression of bFGF mRNA. Conclusions The infiltration of fibroblasts, vascular ingrowth and the synthesis of new collagen is an important mechanism of healing process after autologous fascia reconstruction. BFGF may play an important role in the process and exogenous bFGF could potentiate the healing process.

关 键 词：碱性成纤维细胞生长因子 硬脑膜重建 大鼠 

分 类 号：R651.1[医药卫生—外科学]