多种材料对椎板切除术后粘连干预作用的实验研究  

An Experimental Study with Variable Materials in prevention of peridural adhension after laminetomy

作　　者：张磊[1] 刘璠[1] 张烽[1] 王友华[1] 王洪[1] 刘文虎[1] 

机构地区：[1]南通大学附属医院骨科,江苏226001

出　　处：《交通医学》2012年第4期323-327,共5页Medical Journal of Communications

摘　　要：目的:通过动物实验探索预防椎板切除术后粘连材料的效果,为临床防粘连材料的使用提供新选择。方法:新西兰兔54只,随机分成6组;行椎板切除术动物造模,6组依次设为缺损区旷置组(A组)、小肠粘膜下层覆盖组(B组)、透明质酸纳凝胶覆盖组(C组)、人工骨板覆盖组(D组)、自体脂肪层覆盖组(E组)及地塞米松组(F组)。术后4w,8w,12w分批取材,4w,8w和12w的标本行大体和光镜检查及计算机图像分析;4w和12w的标本行透射电镜检查。结果:A、D、E、F组早期均见硬膜外纤维组织增生明显,B、C组早期硬膜外瘢痕形成少。后期A、C、D、E、F组硬膜外形成致密瘢痕,与硬膜难以分离,B组硬膜外轻度增厚,硬膜外腔未见明显纤维组织增生或粘连。分别按Rydell、改良Nussbaum标准分级,并进行计算机图像分析,统计分析显示B组与A、C、D、E、F组均存在显著差异(P<0.05)。结论:小肠黏膜在预防椎板切除术后硬膜外瘢痕粘连效果优于其它材料。透明质酸钠早期对预防硬膜外粘连有效,长期效果不佳。人工骨自体脂肪和地塞米松对预防椎板切除术硬膜外瘢痕粘连效果不佳。Objective： Several kinds of materials were chosed to prevent adhesion of peridural through animal experiments.Practicability and advantages were analyzed to provide new clinical approaches in clinic.Methods： 54 New Zealand rabbits were used as the animal model and divided into 6 groups randomly.Laminectomy was preformed in lumbar 5（L5） segment of every rabbit.Group A was sutured directly,which was regarded as the control group,Group B was covered with a submucous layer of the small intestine while Group C with sodium hyaluronate gelation,Group D with an artificial bone,Group F with autogenous fat particles and Group F with dexamethasone.The animals were sacrificed at 4,8 and 12 weeks postoperatively.The specimens were prepared for macroscopy,light microscopy,electronmicroscopy and computer image analysis.Results：At the 12th week,macroscopy and light microscopy showed that in Group A,C,D,E and F,peridural scars were dense and wide spread and adhered to dura tightly while less and sparse scars formed in Group B.And there was significant difference between Group B and other groups（P〈0.05）.Conclusion：Small intestine submucosa is better than other materials in preventing peridural adhesion.

关 键 词：腰椎间盘突出症 粘连 椎板切除术 小肠粘膜下层 透明质酸钠 人工骨 自体脂肪 地塞米松 

分 类 号：R681.5[医药卫生—骨科学]