同种异体骨板覆盖预防硬膜外瘢痕粘连的实验研究  

EXPERIMENTAL RESEARCH OF ALLOGENEIC BONE SHEET IN PREVENTING EPIDURAL ADHESION

作　　者：唐欣[1] 杨述华[1] 李宝兴[2] 孙世荃[2] 许伟华[1] 李进[1] 杨操[1] 冯建军[1] 孙立[1] 

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

出　　处：《中国修复重建外科杂志》2006年第8期816-819,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(30471753)~~

摘　　要：目的探讨经冻干辐照处理后的同种异体骨板预防椎板切除术后硬膜外瘢痕粘连的作用。方法12只成年雄性绵羊,随机分成A、B两组,每组6只。两组均作L3、4和L4、5椎板切除,A组的L4、5和B组的L3、4椎板缺损用“H”形同种冻干辐照骨板覆盖,为实验节段;A组的L3、4和B组的L4、5不覆盖骨板作为对照节段。于术后4、8、12、16、20和24周取材,行大体、X线平片和组织切片观察;并对4、24周取材行CT扫描。结果术后4周,实验节段可见同种骨板形态、位置保持完好,椎管内无狭窄,硬膜囊无压迫,镜下椎板咬除缘有多量新生骨小梁生成,周边有大量软骨细胞及其分泌黏多糖和坏死后所留下的空腔,骨板内侧有增生纤维组织及少量炎性细胞浸润;对照节段可见大范围致密的纤维组织夹杂变性坏死肌肉嵌入椎板缺损处,硬膜广泛粘连,硬膜囊受压。术后24周,实验节段椎管重建基本完成,覆盖骨板吸收完全,并与再生椎板融合,椎管形态完好,硬膜外未见瘢痕组织;对照节段椎板再生未完成,瘢痕组织自椎管外嵌入椎管内,压迫硬膜囊及脊髓,硬膜外间隙几乎消失。统计学分析表明手术后期(16～24周),实验节段与对照节段相比硬膜粘连程度明显减轻,椎管矢状径均较对照节段大,硬膜囊形状保持良好,无明显压迫。结论同种异体冻干辐照骨板在实验羊椎板切除后的硬膜外能有效减少瘢痕形成和粘连。Objective To study the effect of the allogeneic bone sheet that has been treated by the freezedrying and radiation sterilization in preventing the epidural adhesion after laminectomy in sheep. Methods Laminectomy was performed on L3.4 and L4.5 of 12 adult male sheep. After operation, one site of L3.4 or L4.s was covered by the allogeneic bone sheet in ＂H＂ shape after the freeze-drying and radiation sterilization treatment ; and the other site was used as a control. The sheep were killed and the specimens were retrieved at 4,8,12,16,20 and 24 weeks after operation to observe the scar formation process. X-ray and CT scan were performed in the segments of L3,4 and L4.5 at 4 and 24 weeks. Results Four weeks after operation, the position and the shape of the allogeneic bone sheet were good in condition, and no lumbar spinal stenosis or compression of the dura was found in the experimental sections. Twentyfour weeks after operation the examination on the experimental sections revealed that the vertebral canal reconstruction was completed, the allograft was absorbed almost completely, and inosculation with the lamina of the vertebra and the shape of the lumbar spine were good, with no fibroid tissues found in the epidural area. Compared with the control segment, the dura adhesion degree in the laminoplasty segment was significantly decreased （P〈0. 01）, and the dura sac remained in a good shape. There was no obvious compression on the dura. Conclusion The allogeneic bone sheet after the treatment of freeze-drying and radiation sterilization can effectively reduce the scar formation after laminectomy and prevent postoperative recurrence of the spinal stenosis.

关 键 词：椎板切除术 异体骨移植 预防 硬膜外粘连 

分 类 号：R687.3[医药卫生—骨科学]