几丁糖防硬膜外粘连的实验与临床研究  

The effect of chitosan in the prevention of fibrous scar tissue formation following laminectomy

作　　者：王秋根[1,2] 项耀钧[1,2] 侯春林 吴岳嵩[1,2] 杨锡铭[1,2] 顾雄华 徐卫东[1,2] 康一凡 

机构地区：[1]第二军医大学附属长海医院骨科 [2]第二军医大学附属长征医院骨科

出　　处：《中华显微外科杂志》1999年第1期40-42,共3页Chinese Journal of Microsurgery

基　　金：国家自然科学基金

摘　　要：目的观察选择性脊神经后根切除术（ＳＰＲ）椎板切除术后硬膜外几种防瘢痕粘连物质的作用及其机制。方法用４８只ＳＤ大鼠制作硬膜外周围粘连模型，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４、８、１２周观察瘢痕形成情况并测定胶原纤维含量。ＳＰＲ术后临床上用不同防粘连方法共２１６例。分４组即Ａ组硬膜外未作任何防粘连措施１５例；Ｂ组硬膜外涂布几丁糖作防粘连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１０９例；Ｄ组硬膜外涂布透明质酸钠作防粘连２８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，其他依次为Ｂ组、Ｄ组、Ａ组。结论几丁糖对硬膜外周围瘢痕形成、粘连有明显预防作用。Objective To study the effect of chitosan in the prevention of fibrous scar formation in the epidural space after laminectomy Methods\ Fourty eight SD rats were used as the animal model in this study Laminectomy was performed in lumber 1,and the exposed dura were covered with hyaluronate(group A),free fat(group B),chitosan (group C),and saline solution (group D) 4,8 and 12 weeks postoperation,scar formation was observed 188 cases of spastic cerebral palsy was carried out in group A,15 patients underwent SPR without any prevention of adhesion ln group B,the duras of 64 patients were covered with chitin ln group C,the duras of 109 patients were covered with chitin and autogenous fat with blood supply ln group D,the duras of 28 patients were covered with hyaluronate Half a year after operation,evaluation based on function and MRI Results\ The results revealed that scar formed in group D at the fourth week,reached a peak at the eighth week and began to soften and constrict at the twelfth week Sodium hyaluronate and chitosan had a significant efficacy in the prevention of scar formation,but the effect of chitsan was superior to that of sodium hyaluronate Clinic 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

关 键 词：椎板切除术 几丁糖 硬膜外粘连 预防 

分 类 号：R681.505[医药卫生—骨科学]