改良经皮球囊导管法建立山羊急性脊髓损伤模型  

A modified goat model of acute spinal cord compression injury from a percutaneous balloon catheter：method feasibility and preliminary observation

作　　者：黄轩[1] 陈智[1] 王琨[1] 何平[1] 李凤宁[1] 张帆[1] 綦柯[1] 宋庆鑫[1] 汤译博[1] 唐沂星[1] 侯藏龙[1] 沈洪兴[1] 

机构地区：[1]第二军医大学长海医院骨科,上海200433

出　　处：《中华医学杂志》2013年第37期2993-2996,共4页National Medical Journal of China

基　　金：上海市浦江人才计划（10PJ1412500）;上海市科委基础研究重点科技项目（11JC1415600）

摘　　要：目的 探讨应用经皮穿刺技术向椎管内置入球囊导尿管致急性脊髓压迫性损伤动物模型的方法.方法 12只崇明山羊分为对照组（A组）、0.5 ml压迫组（B组）和1 ml压迫组（C组）.选择腰-骶椎板间隙体表投影处为穿刺点,局麻后使用血管经皮穿刺鞘管,将5Fr球囊导尿管输送至硬膜外腔,透视下确认导尿管头端到达T6水平.1周后分别以0.5和1 ml容量扩张B、C组导尿管球囊,持续压迫脊髓30 min后撤除.各组动物均在穿刺操作及球囊扩张前后接受CT和MRI检查,计算球囊导管的椎管侵占率,并采用改良Tarlov评分评估神经功能.分别于球囊扩张后48 h及72 h处死每组各2只动物,取压迫节段脊髓送检病理.结果 所有动物均顺利置管.CT测得置管后A～C组椎管侵占率依次为6.8％±0.7％、6.7％±0.7％和6.6％±0.6％.扩张球囊后B、C组椎管内侵占率分别增加到43.4％±2.5％和88.1％ ±2.3％;MRI提示球囊扩张后对脊髓腹侧右侧半形成压迫.置管后各组动物神经功能无明显受损,球囊扩张后B、C组出现后肢运动障碍.除A组外,病理检查显示球囊扩张压迫48 h后,相应节段脊髓呈现灰质内神经元胞体缩小,数量减少,胞体周围间隙增大,白质轻度脱髓鞘,部分轴突空泡样变;压迫72 h后病理改变明显加重.结论 球囊扩张后神经、影像和病理学的评估结果符合急性脊髓压迫性损伤的特点.经皮穿刺置管技术能够避免破坏脊髓正常生理环境,模拟符合临床实际的闭合损伤机制,是一种可行性较高的脊髓损伤建模方法.Objective To establish a goat model of acute spinal cord compression injury through a modified percutaneous technique with a Foley double-lumen urine catheter and explore the method feasibility and preliminary observation.Methods Twelve adult male Chongming goats were randomly divided into 3 groups：control （A,n =4）,0.5 ml compression （B,n =4） and 1 ml compression （C,n =4）.After local anesthesia,all animals received epidural balloon catheter （5Fr） insertion via a percutaneous trans-lumbosacral interlaminar space technique that mimicked the method used in vascular access for angiography.The balloon catheter was advanced under fluoroscopic guidance until its distal tip reached the middle of T6 level.One week later,for groups B and C,the balloon was inflated by half-strength contrast material,0.5 ml and 1 ml,respectively.The balloon was left inflated for 30 min and then deflated.The images of computed tomography （CT） and magnetic resonance （MR） were taken before and after surgical procedures.Quantitative assessment of spine canal occupying rate was accomplished by an off-fine software program based on CT results.Motor function was assessed by the modified Tarlov scale.Two animals of each group were sacrificed after a total observation period of 48 h and 72 h respectively.Spinal cords from the injured level were then obtained for pathologic examinations.Results All animals underwent successful catheterization occupying 6.8% ± 0.7% （Group A）,6.7% ± 0.7% （Group B） and 6.6% ± 0.6% （Group C） of spine canal respectively.After inflation,the occupying rate of groups B and C achieved 43.4% ±2.5% and 88.1% ± 2.3% respectively.Ventral compression of spinal cord was noted on MR images.Hindlimb movement remained normal after catheter insertion in all groups.All animals in group B and C became paraplegic after inflation.And a positive correlation existed between injection volume and Tarlov score.Pathological findings confirmed neuron atrophy,increased gap around neurons,mild demyelination

关 键 词：脊髓损伤 硬膜外球囊导管 球囊压迫 动物模型 

分 类 号：R651.2[医药卫生—外科学]