DL-PLA可吸收膜预防硬膜外粘连的临床研究  

Clinical study on prevention of epidural adhesion with absorbable DL-PLA membrane

作　　者：李志钢[1] 李海东[1] 徐钧[1] 石勇[1] 罗鹏[1] 肖耀广[1] 宋建东[1] 

机构地区：[1]湖北省新华医院骨科,武汉 430015

出　　处：《中国医师进修杂志（外科版）》2007年第7期19-21,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的观察消旋聚乳酸（DL-PLA）可吸收膜在预防脊柱手术后硬膜外粘连的临床应用效果。方法对2004年12月-2006年4月收治的63例腰椎骨折、滑脱患者行椎板减压内固定术。随机分为两组：A组（31例）术中使用DL-PLA可吸收膜覆盖于硬膜外，B组（32例）术中则没有使用DL-PLA可吸收膜。观察患者术后9个月后脊柱的MRI影像学结果和治疗效果，对比两组手术前后的MRI影像学资料和治疗效果。结果9个月后对比脊柱MRI影像学中瘢痕及粘连的程度，A组有13例见轻度瘢痕组织影像，无明显硬膜粘连及压迫硬膜的现象；B组31例有瘢痕形成，22例有粘连，16例有轻度压迫，5例压迫明显，其中2例有明显神经根水肿。A组硬膜外瘢痕形成及粘连明显少于B组（P〈0．01）。A组术后9个月临床疗效优23例，良8例，差0例；B组优18例，良11例，差3例。A组疗效优于B组（P〈0．05）。结论DL-PLA可吸收膜能较好地预防及减轻脊柱术后硬膜外粘连，提高手术治疗效果。Objective To observe the clinical effect of the application absorbable DL-PLA membrane on the prevention of epidural adhesion after larninectomy. Methods From December 2004 to April 2006,63 cases with fracture of lumbar vertebra or spondylolishesis were treated with total laminectomy. The absorbable DL-PLA membrane were used in the experimental group （group A）and not used in the control group（group B ）. The manifestation of MRI were contrasted at 9 months postoperatively between group A and group B. Results In group A,there were 13 cases with cicatricle tissue,in which there was no epidural adhesion. In group B, there were 31 cases with cicatricle tissue, in which there were 22 cases of epidural adhesion and 21 cases of spinal dura mater compression. The degree of the epidural cicatricle and adhesion in group A was lower than those in group B （P〈 0.01 ）. After 9 months,the clinical effects were excellent in 23 and 18 cases,good in 8 and 11 cases,and lair in 0 and 3 cases in group A and group B respectively. There was statistics difference between the group A and group B（P 〈 0.05 ）. Conclusion The absorbable DL-PLA membrane is the reliable and effective material to reduce the epidural adhesion.

关 键 词：聚乳酸 硬膜外 粘连 

分 类 号：R687[医药卫生—骨科学]