新型人工椎板预防后路椎板切除术后瘢痕粘连的实验研究  

NOVEL ARTIFICIAL LAMINA FOR PREVENTION OF EPIDURAL ADHESIONS AFTER POSTERIOR CERVICAL LAMINECTOMY

作　　者：吕超亮[1,2] 宋跃明[1] 刘浩[1] 刘立岷[1] 龚全[1] 李涛[1] 曾建成[1] 孔清泉[1] 裴福兴[1] 屠重棋[1] 段宏[1] 

机构地区：[1]四川大学华西医院骨科,成都610041 [2]济宁市第一人民医院骨科

出　　处：《中国修复重建外科杂志》2013年第7期829-835,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家"十一五"科技支撑计划课题资助项目(2007BAE131304)~~

摘　　要：目的评价使用新型氨基酸聚合物(multi-amino-acid copolymer,MAACP)复合纳米羟基磷灰石(nano-hydroxyapatite,n-HA)人工椎板在山羊颈椎椎板切除术后阻隔硬膜外瘢痕粘连、压迫的应用价值。方法 2岁龄雄性山羊15只,体重(30±2)kg,随机分为实验组(n=9)和对照组(n=6)。实验组行C4椎板切除,MAACP/n-HA人工椎板植入;对照组仅行C4椎板切除。术后4、12、24周分别取实验组2、2、5只,对照组2、2、2只山羊,行大体观察伤口感染、人工椎板有无移位碎裂、椎管形状等,并根据大体观察Rydell瘢痕粘连程度评级标准评价两组手术节段粘连程度;行X线片、CT影像学观察,24周时测量C3、C4、C5椎管面积及椎管矢状径,以正常山羊(n=2)作为正常组;24周MRI观察脊髓神经是否受压;然后处死取材,行组织学观察。结果术后所有动物切口愈合良好,未见毒性及免疫排斥反应。术后实验组手术节段粘连程度明显优于对照组(Z=—2.52,P=0.00)。术后各时间点X线片及CT观察示实验组人工椎板位置无移位,外形完整,骨性椎管逐渐得到重建;对照组C4椎板及棘突缺损,软组织影突入椎管。术后24周,C4椎管面积和椎管矢状径实验组和正常组均显著高于对照组(P<0.05),实验组与正常组比较差异无统计学意义(P>0.05)。实验组MRI示C4平面脑脊液信号通畅,无软组织突入椎管,硬膜无粘连受压;对照组椎板缺损处瘢痕组织突入椎管与硬膜粘连,硬膜轻度受压。组织切片HE染色及Masson三色染色示实验组人工椎板完整无明显降解,人工椎板与自体骨结合界面周围少量成骨;对照组椎板缺损处纤维组织长入。结论新型MAACP/n-HA人工椎板可在体内长久维持生物力学稳定,对周围瘢痕向椎板缺损处生长有良好机械阻隔作用。Objective To evaluate the application of artificial lamina of multi-amino-acid copolymer （MAACP）/nano-hydroxyapatite （n-HA） in prevention of epidural adhesion and compression of scar tissue after posterior cervical laminectomy. Methods Fifteen 2-year-old male goats [weighing, （30 ± 2） kg] were randomly divided into experimental group （n=9） and control group （n=6）. In the experimental group, C4 laminectomy was performed, followed by MAACP/n-HA artificial lamina implantations; in the control group, only C4 laminectomy was performed. At 4, 12, and 24 weeks after operation, 2, 2, and 5 goats in the experimental group and 2, 2, and 2 goats in the control group were selected for observation of wound infection, artificial laminar fragmentation and displacement, and its shape; Rydell’s degree of adhesion criteria was used to evaluate the adhesion degree between 2 groups. X-ray and CT images were observed; at 24 weeks after operation, CT scan was used to measure the spinal canal area and the sagittal diameter of C3, C4, and C5 vertebrea, 2 normal goats served as normal group; and MRI was used to assess adhesion and compression of scar tissue on the dura and the nerve root. Then goats were sacrificed and histological observation was carried out. Results After operation, the wound healed well; no toxicity or elimination reaction was observed. According to Rydell’s degree of adhesion criteria, adhesion in the experimental group was significantly slighter than that in the control group （Z= — 2.52, P=0.00）. X-ray and CT scan showed that no dislocation of artificial lamina occurred, new cervical bone formed in the defect, and bony spinal canal was rebuilt in the experimental group. Defects of C4 vertebral plate and spinous process were observed in the control group. At 24 weeks, the spinal canal area and sagittal diameter of C4 in the experimental group and normal group were significantly larger than those in the control group （P 〈 0.05）, but no significant difference was found between exper

关 键 词：纳米羟基磷灰石 氨基酸共聚物 人工椎板 瘢痕组织 椎板切除 山羊 

分 类 号：R687.3[医药卫生—骨科学]