钛网椎管重建对硬膜外瘢痕粘连形成影响的实验研究  

Experimental study on the effect of application of titanium rete for spinal canal reconstruction on peridural fibrosis formation after total laminectomy

作　　者：钟锐[1] 林慰光[1] 林本丹[1] 胡奕山[1] 郑干轩[1] 洪笃开[1] 

机构地区：[1]广东省汕头市中心医院外七科,汕头市外马路114号515031

出　　处：《中国矫形外科杂志》2013年第5期502-506,共5页Orthopedic Journal of China

摘　　要：[目的]探讨全椎板切除后采用钛网椎管重建能否减少术后硬膜外瘢痕粘连形成。[方法]以16只成年家兔为实验对象,随机分成A、B两组,每组8只。建立L_3椎体全椎板切除模型,A组为对照组,建模后不做特殊处理,彻底止血后闭合切口;B组作为实验组,建模后将"V"形钛合金网固定并覆盖于减压节段之上,完成椎管重建。于术后8周对手术部位行X线片检查,对比观察骨质愈合及钛网位置情况,随后处死实验动物,对椎板切除部位进行大体和组织学观察,并分别进行硬膜外粘连程度等级评分,结果采用等级资料的秩和检验进行比较。[结果]所有实验动物伤口均一期愈合。术后8周X线提示实验组中有6例可见到新生骨组织与钛网融合成片,形成椎板样结构,对照组中亦有4例硬膜外可见到再生的高密度骨组织。两组动物间椎板切除处骨愈合情况无统计学差异(P>0.5)。B组的Rydell-Balazs大体粘连度评分,He-Revel组织学评分均显著优于A组(P<0.5)。[结论]本实验结果显示全椎板切除后钛网椎管重建可减少术后硬膜外瘢痕的形成,并且钛网的存在未影响椎板切除处的骨愈合。[ Objective] To evaluation of the effectiveness of application of titanium rete for spinal canal reconstruction on formation of the peridural fibrosis in rabbit model performed total laminectomy. [ Methods ] Sixteen rabbits were divided ran- domly into 2 groups ： group A （ the experimental group） and group B （ the control group） . L3 total lamineetomy were performed on each animal. The incisions of group A were closed after laminectomy; for spinal canal reconstruction, ＂V＂ - shape titanium fete was placed upon the decompression area of group B and fixed by thread after laminectomies. At 8 weeks after surgery, the animal underwent X -film examination in order to compare the healing of bone and location of titanium rete . Then the rabbits were sacrificed and the spinal cords with an intact dural covering were harvested. Peridural adhesions were evaluated and graded grossly and histologically. The results were compared statistically by using the Wilcoxon Rank Sum test. [ Results ] The recovery of all rabbits was uneventful after the operations. The X - film showed the bone - regeneration and titanium rete grew into the shape of vertebral lamina in 6 rabbits of group B, and the same bone - regeneration was also identified in 4 rabbits of group A. The bone - healing showed no statistical difference between the two groups （ P 〉 0. 5 ） . There were significant differences in the peridural fibrosis grades between the experimental groups and the control group （ P 〈 0. 5 ） according to Rydell - Balazs score and He - Revel score. [ Conclusion] Our study results suggest that the application of titanium rete for spinal canal reconstruc- tion can be effective in reducing the peridural adhesions in rabbit total laminectomy model and the titanium rete doesnt affect the bone - healing of decompression area.

关 键 词：椎板切除术  钛网  硬膜粘连  椎管重建 

分 类 号：R687.3[医药卫生—骨科学]