同种异体骨板覆盖预防椎板切除术后硬膜粘连的研究  

Experimental Research and Clinical Application of Laminoplasty Using Allogeneic Freeze-drying, Radiation Sterilization Bone Sheet

作　　者：杨述华[1] 唐欣[1] 许伟华[1] 李进[1] 李宝兴[2] 孙世荃[2] 张育敏[2] 康悦[2] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,湖北武汉430022 [2]中国辐射防护研究院山西省医用组织库,山西太原030000

出　　处：《实用骨科杂志》2006年第1期20-24,共5页Journal of Practical Orthopaedics

摘　　要：目的 探讨同种异体骨板覆盖在预防椎板切除术后硬膜粘连方面的作用。方法 a）实验研究：12只成年雄性公绵羊行L3～4和L4～5全椎板切除后．在其中一处用“H”型同种异体冻干辐照骨板覆盖，另一处作自身对照。于术后4、8、12、16、20、24周取材．行大体、X线平片和光镜观察；并对4、24周取材行CT扫描。b）临床应用：21例节段性腰椎间盘突出或腰椎管狭窄患者行全椎板切除．“H”型同种异体冻于辐照骨板覆盖。术后随访0．5～1．5a，观察临床症状及CT、MRI表现。结果 a）实验研究：与对照节段相比重建节段硬膜粘连程度明显减轻（P〈0．01）．椎管内容积无明显改变，硬膜囊形状保持良好．无明显压迫；b）临床应用：18例患者疼痛基本或完全消失，恢复原来的生活和工作，另3例较术前有明显好转；CT、MRI显示椎管扩大，骨板无倾斜、移位，脊髓无压迫；均未见排异反应；术后1．5a，椎管内容物形态良好，骨板两侧已与相邻骨组织融合，密度相同。结论 同种异体冻干辐照骨板具有良好的生物相容性、生物力学性能和诱导成骨作用，是一种良好的硬膜外覆盖材料，能有效阻止硬膜外粘连，防止术后再狭窄，可用于节段性椎板覆盖成形术。Objective To discuss the value of allogeneic freeze-drying, radiation sterilization bone sheet in preventing post-laminectomy complications. Methods a）Animal study： L3/4or L4/5was covered by allogeneic freeze-drying. radiation sterilization bone sheet in ＂H＂ shape while the other site was remained as control. The 12 sheep were sacrificed and the specimen were retrieved in 4, 8, 12. 16, 20 and 24 weeks after operation to observe scar formation process. X-ray and CT scan was made in both segments of L3/4and L4/5in 4 and 24 weeks, b）Clinical application： Laminectomy were performed in twenty-three patients with segmental lumber disc herniation or lumber spinal stenosis, allogeneic freeze-drying, radiation sterilization bone sheet in ＂H＂ shape were used to cover the vertebral laminae. All patients were followed up for 0.5～1.5 years to observe their clinical symptoms and CT,MRI presentations. Results a）Animal study： Compared with the control segment, the dura adhesion degree in the laminoplasty segment decreased significantly（P〈0.01 ）, and the dura sac remained in good shap. There was no distinct compression to the dura. b）Clinical application： In 0.5～ 1.5 years follow-up duration, eighteen patients achieved pain free and regained their normal life and occupational activities. The symptoms and signs in the other three patients improved significantly. CT scan and MR imaging showed the spinal canal had been extended. There was no tile or displacement of the femoral sheet or compression of the spinal cord. There was no rejective reaction observed in this study. The edge of the allograft is inosculated with connective lamina of vertebra, the shape of lumber spinal is good one and a half years after operation. Conclusion Due to its good biocompatibility, biomechanical characters and osteogenic ability, allogeneic freeze-drying, radiation sterilization bone sheet is an ideal material for extradural laminoplasty. It can effectively reduce the post-laminectomy scar formation and prevent recurr

关 键 词：同种 辐照 冻干 骨移植 椎板切除术 手术后并发症 硬膜外腔 瘢痕 

分 类 号：R681.53[医药卫生—骨科学]