预防椎板切除术后硬膜周围纤维化与粘连的实验研究  

Prevention of Peridural Fibrosis and Adhesion af-ter Laminectony: An Experimental Study in Rats

作　　者：孙康[1] 姜长明[1] 吕德成[1] 张维国[1] 王霞[1] 毛建民[1] 曹国英 黄为 

机构地区：[1]大连医科大学第一附属医院骨科,大连医科大学第一附属医院磁共振室,大连医科大学第一附属医院病理教研室,中科院大连化物所九室,济南军区军医学校

出　　处：《中华骨科杂志》1995年第11期728-731,共4页Chinese Journal of Orthopaedics

摘　　要：以９６只ＳＤ大鼠全椎板（Ｌ＿（１～２））切除为实验模型，研究了高分子纤维（ＨＵｃＭＣ）、透明质酸钠（ＳＨＡ）、游离脂肪（ＦＦ）在预防硬膜周围纤维化与粘连中的作用。通过肉眼、光镜、电镜观察，电子计算机图像分析，增强ＭＲＩ扫描，结果显示：椎板切除后硬膜周围纤维化的高峰在术后８周内。ＨＵＣＭＣ生物相容性好、能降解、可吸收、药物局部存留时间长、覆盖均匀、作用完善、可起到三维的遮挡保护作用，能有效地防止椎板切除后硬膜周围的纤维化与粘连。ＳＨＡ早期防止纤维化与粘连有一定作用，晚期作用不明显。ＦＦ虽然可防止硬膜周围纤维化与粘连，但感染率高，脂肪萎缩与坏死严重，晚期几乎均不同程度向椎管内嵌入，甚至造成脊髓和神经根受压。AbstractAnexperimental study of the effectiveness of vari-ou s ma terials including carboxymeth ylcel lulose combinedwith cross-Linker(HUCMC ), Sodium hyaluronic acid(SHA),Free fat(FF)in prevention of peridural fibrosisand adhesion (PDFA ) was done in 96 SD rats,under-gone total laminectomy ( L_(1～2)). PDFA was measured,using a double-blind protocol at 2、4、8、12 weeks postop-eratively by gross anatomical appearance ( blunt-dissec-tion), microscpical evaluation, computed imaging anal-ysis, MRl enhanced with gadolinium. The resultsdemonstrated that the peak of PDFA is within 8 weeksafter operation. HUCMC has a good biocompatibility; itmay be degrageted and absorbed; and may remain activein situ for a iong enough period. covering evenly withbest qualities and can be used for three dimensional pro-tection; so that it can effectively inhiht PDFA afterlaminectomy. SHA has some effect in the early stage,however it has not so active later on. The FF group,though can effectively prevent PDFA,its rate of incisioninfection is high, and the atrophy and necrosis of FF se-rious, Further more, nearly all the transplanted fat re-mained in situ extended into the spinal cord to sOme ex-tent 8 weeks postoperatively.

关 键 词：椎板切除术 硬脊膜 粘连 纤维化 游离脂肪移植 

分 类 号：R687.4[医药卫生—骨科学]