羊膜预防椎板切除术后硬膜外粘连的实验研究  

Experimental study on prevention of postlaminectomy adhesions with amnion

作　　者：朱勋兵[1] 周建生[1] 潘功平[1] 肖玉周[1] 

机构地区：[1]蚌埠医学院附属医院骨科,安徽蚌埠2330004

出　　处：《蚌埠医学院学报》2006年第2期129-131,F0004,共4页Journal of Bengbu Medical College

摘　　要：目的：探讨羊膜在预防椎板切除术后硬膜外粘连的作用及可能机制。方法：对60只中国白兔行L5水平椎板切除术后，据术前随机分组，分别在硬膜外覆盖羊膜（羊膜组）、几丁糖膜（几丁糖膜组），空白对照组不做任何覆盖。术后2、4、8、12周每组分别处死5只动物，通过双盲法对所取标本做组织学观察及计算机辅助图像分析。结果：空白对照组暴露的硬膜发生广泛粘连，硬膜外腔几乎消失；羊膜组和几丁糖膜组硬膜外瘢痕稀少，硬膜表面光滑，硬膜外形成潜在腔隙，维持了硬膜外的有效空间。不同时间段三组间粘连度评价以羊膜组最低，几丁糖膜组次之，空白组最高，差异均有显著性（P〈0．05～P〈0．01）。结论：在硬膜和骶棘肌间放置合适的材料可预防硬膜外粘连；羊膜能预防硬膜外瘢痕向椎管内延伸，是一种有效预防硬膜外粘连的生物相容性材料。Objective：To investigate the role of amniotic membrane in the prevention of epidural adhesion after lamineetomy and to find out the related mechanism. Methods： Laminectomy was performed in the lumbar 5 sector of 60 rabbits, and the exposed dura mater was covered with amniotic membrane（ group AM）, chitosan membrane （group CHS）, and no covering in the control group（ group CON） respectively. Five animals in each group were sacrificed at 2,4,8,12 weeks postoperatively. By using a double blind protocol, the specimens were prepared for histological study and computer-assisted image analysis. Results：In the control group, the adhesion of the dura mater to the sear tissue occurred to the entire exposed surface and the extradural space almost disappeared. In group AM and CHS, the formation of epidural scar was much less than that in the control group. The dura mater was smooth and a gap had formed in the epidural cavity. The epidural space was well preserved. Group AM had the lowest adhesion evaluation index, and there was statistical difference（ P 〈0.05-P 〈0.01 ）. Conclusions：Putting a suitable obstructer between the dura mater and the erector spinal muscle can prevent the extension of epidural scar into the spinal canal and make dura exempted from adhesion. Amniotic membrane is an effective biocompatible material in preventing epidural scar.

关 键 词：椎板切除术 粘连 羊膜 几丁糖膜 

分 类 号：R681.5[医药卫生—骨科学] R619.9[医药卫生—外科学]