防硬膜外粘连的实验研究与临床观察  

Prevention of Fibrous Scar Tissue Formation Following Laminectomy: Experimental and Clinical Study

作　　者：王秋根 项耀钧 侯春林 吴岳嵩 杨锡铭 顾雄华 徐卫东 康一凡 

出　　处：《中华骨科杂志》1998年第7期408-410,共3页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金

摘　　要：目的：观察椎板切除术后防止硬膜外瘢痕粘连的几种物质及其作用机制。方法：用４８只ＳＤ大鼠制作硬膜外损伤模型，在损伤的硬膜表面涂布透明质酸钠、自体游离脂肪、几丁糖、生理盐水，分别于术后４、８、１２周观察瘢痕形成情况并测定胶原纤维含量。椎板切除术中临床上用不同防粘连方法共１８８例。分３组，即Ａ组硬膜外未做任何防粘连处理共１５例。Ｂ组硬膜外涂布几丁糖以防粘连共６４例。Ｃ组为硬膜外涂布几丁糖的同时加自体硬膜外带血供脂肪覆盖共１０９例。术后半年进行功能评定和ＭＲＩ检查。结果：生理盐水组大鼠硬膜外瘢痕自第４周开始形成，于第８周达高峰，１２周时开始软化、收缩。透明质酸钠与几丁糖预防瘢痕形成均有明显效果，其中几丁糖明显优于透明质酸钠。组织相容性自体游离脂肪最好，其次是几丁糖、透明质酸钠。临床结果Ｃ组为最佳防粘连方法，Ｂ组其次，Ａ组明显差于上述两组。结论：几丁糖对硬膜外周围的瘢痕形成、粘连有明显预防作用。bjective: To study the effect of several substances in the prevention of fibrous scar formation in the epidural space after laminectomy. Methods:Fortyeight SD rats were used as the animal model in this study. Laminectomy was performed in lumbar 1 segment,and the exposed duras were covered with hyaluronate(group A),free fat(group B),chitin(group C),and saline solution(group D) respectively. Scar formation and quantity of collagen were studied 4,8 and 12 weeks postoperatively. Clinically, 188 cases of spastic cerebral palsy were studied. In group A, 15 patients underwent SPR without any prevention measure of adhesion formation. In group B, the duras of 64 patients were covered with chitin. In group C, the duras of 109 patients were covered with chitin and autogenous fat with blood supply. Evaluation was based on function and MRI half a year after operation. Results: Experimentally, scar formed in group D at the fourth week, reached a peak at the eighth week and began to soften and shrink at the twelfth week. Sodium hyaluronate and chitin had a significant efficacy in the prevention of scar formation, but the effect of chitin was superior to that of sodium hyaluronate. Clinical studied showed that group C had the best prognosis, then group B and group A the poorest. Conclusion: The findings of this study indicate that chitin has a preventive effect on scar tissue formation after laminectomy.　　

关 键 词：椎板切除术 硬膜外粘连 预防 几丁糖 瘢痕 

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