地塞米松明胶海绵预防硬脊膜外粘连  

Dexamethasone-soaked gelatin sponges prevent epidural adhesion

作　　者：方怀玺[1] 张明[1] 乐国平[1] 

机构地区：[1]广西医科大学第四附属医院骨三科,广西壮族自治区柳州市545005

出　　处：《中国组织工程研究》2015年第8期1165-1169,共5页Chinese Journal of Tissue Engineering Research

基　　金：广西科技厅科研计划课题(桂科攻10124001B-26);课题名称:应用地塞米松明胶海绵对腰椎间盘摘除术疗效影响的实验及临床研究~~

摘　　要：背景:临床上在腰椎间盘摘除中将地塞米松明胶海绵复合物放置在神经根和硬脊膜周围取得了良好的效果。目的:通过动物实验了解地塞米松明胶海绵复合物预防硬脊膜外粘连的效果。方法:将40只新西兰白兔随机均分为4组,均切除L4、L7椎板,造成1.0 cm×0.5 cm的硬脊膜裸露区后,其中3组分别在硬脊膜与神经根表面覆盖地塞米松明胶海绵、注射地塞米松及覆盖明胶海绵,以不用任何间置物覆盖的为空白组。术后2,4,6,8,12周完整取下整个手术节段椎体及其附件和椎旁肌,大体及组织学观察神经根及硬脊膜粘连程度。结果与结论:术后12周,地塞米松明胶海绵组大体见椎板缺损处有新生骨形成,硬脊膜周围有黄白色膜性组织,可分离,组织学见脂肪细胞结构完整,与硬脊膜之间分界明显,无瘢痕细胞形成,无粘连,软骨细胞及骨小梁增生;地塞米松组、明胶海绵组、空白组大体见硬脊膜外围有大量瘢痕组织,与硬脊膜粘连严重,无法钝性分离,组织学见芽组织胶原化,硬脊膜增厚,粘连严重。表明地塞米松明胶海绵复合物可预防硬脊膜外粘连。BACKGROUND：Clinicaly, dexamethasone-soaked gelatin sponges that are placed around the nerve root and spinal dura mater in lumbar disc excision have achieved good results. OBJECTIVE： To understand the effect of dexamethasone-soaked gelatin sponges in prevention of epidural adhesion in animals. METHODS：Forty New Zealand white rabbits were randomly divided into four groups folowed by removal of L4, L7 laminae, and a 1.0 cm×0.5 cm lamina dura area was exposed in each group. Then, the dura and nerve root were covered with dexamethasone-soaked gelatin sponges, dexamethasone, gelatin sponge and nothing （blank group）, respectively. At 2, 4, 6, 8, 12 weeks after surgery, the entire operated vertebral segment and its accessories and paraspinal muscles were taken for gross and microscopic observation of nerve root and dural tissue adhesions. RESULTS AND CONCLUSION：At 12 weeks postoperatively, new bone tissue formed generaly at the site of laminectomy defect in the dexamethasone-soaked gelatin sponge group, with separable yelow-white membranous tissue around the dura; histological results showed the complete structure of fat cels, clearly distinct from the dura; there was no scar cel formation, no adhesions, no trabecular bone cartilage cels and hyperplasia. In the other three groups, a large number of peripheral epidural scar tissues were generaly seen, epidural adhesions were serious that could not be separated bluntly, and histological results showed colagenization of granulation tissue, dural thickening and serious adhesions. The findings indicate that dexamethasone-soaked gelatin sponges can synergisticaly prevent epidural adhesions.

关 键 词：生物材料 材料相容性 地塞米松 明胶海绵 椎板切除 硬脊膜 粘连 

分 类 号：R318[医药卫生—生物医学工程]