损伤控制手术治疗兔脊髓压迫性损伤的效果  

Damage control orthopedics for spinal cord compression injury in rabbits

作　　者：周建[1] 李坤[1,2] 车立新[2] 艾力夏提[2] 周圣泉 ZHOU Jian LI Kun CHE Lixin et al(The Xinjiang Uiger Municipal People＇s Hospital Clinical College of Anhui Medical University, 830001, Urumchi, China)

机构地区：[1]安徽医科大学新疆临床学院,乌鲁木齐市830001 [2]新疆维吾尔自治区人民医院脊柱外科,乌鲁木齐市830001 [3]武警江苏总队南京医院,南京市210000

出　　处：《中国脊柱脊髓杂志》2017年第2期159-168,共10页Chinese Journal of Spine and Spinal Cord

基　　金：新疆维吾尔自治区自然科学基金面上项目(2014211A060)

摘　　要：目的:探讨损伤控制手术(damage control operation)治疗兔脊髓压迫性损伤的效果。方法:应用球囊压迫法制备新西兰大白兔脊髓压迫损伤模型45只,造模术后2d随机取5只完成行为学观测、评分后取出损伤区脊髓组织进行流式细胞仪凋亡细胞检测、病理学观察、免疫组化染色检测兔损伤区脊髓组织中基质金属蛋白酶2(MMP-2)表达(对照组),剩余40只随机分为两组,每组20只,一组采用损伤控制手术(A组),即减压术前先将球囊内压力减为原来一半,使椎管内有效容积增加后再自远离脊髓压迫较重的一侧进行全椎板减压;另一组直接予全椎板切除减压,减压自压迫最严重部位开始(B组),两组减压完毕后均取出球囊,并在减压术后1d、3d、7d、14d分别随机取5只实验兔完成以上检测内容。结果:对照组造模术后48h的Tarlov评分为1.20±0.45分,A、B组减压术后1d时Tarlov评分与对照组比较均无统计学差异(P>0.05);A、B组减压术后1d、3d、7d时的Tarlov评分均无统计学差异(P>0.05),减压术后14d时A组高于B组(P<0.05)。对照组脊髓细胞凋亡率为(2.66±1.40)%,A、B组减压术后1d时脊髓细胞凋亡率均低于对照组(P<0.05);减压术后1d、3d时A、B两组损伤区脊髓细胞凋亡率无统计学差异(P>0.05);A、B组减压术后1d与3d、7d与14d损伤区脊髓细胞凋亡率无统计学差异(P>0.05);A、B组减压术后3d与7d损伤区脊髓细胞凋亡率均有统计学差异(P<0.05);减压术后7d、14d时A组损伤区脊髓细胞凋亡率均低于同时间点B组(P<0.05)。病理学观察显示对照组白质轻度脱髓鞘、部分轴突空泡样变,灰质内细胞水肿,A、B组减压术后1d、3d、7d、14d白质弥漫性脱髓鞘改变及散在点状出血,灰质内细胞水肿伴神经细胞变性逐渐加重,至减压术后7d时灰质内广泛神经细胞变性,并持续到术后14d。对照组MMP-2表达阳性细胞率为(45.76±0.75)%,A、B组减压术后1d时MMP-2表达阳性率均�Objectives： To investigate the operation procedures and outcomes of damage control operation for spinal cord compression injury in rabbits. Methods： The animal models of spinal cord compression injury were established by balloon compression in 45 white New Zealand rabbits. Decompression began 2 days after the first operation. 5 rabbits were randomly selected from the 45 models to carry on the following researches two hours after operation（control group）： behavioral science, apoptotic spinal cord cells detected by flow cy- tometry, and expression of matrix metallopeptidase-2（MMP-2） detected by histopathological and immunohisto- chemical staining. The remaining 40 rabbits were randomly divided into 2 groups, 20 cases in each group. In the first group, the total laminectomy began far from the heavy oppressed side of spinal cord after balloon pressure reduced to half（contralateral decompression group, group A）. In the second group, the whole vertebral plate was resected from the heavily oppressed side （ipsilateral decompression group, group B）. Then the balloons were took out after decompression in the 2 groups. 5 rabbits were randomly and respectively taken from the 2 groups at ld, 3d, 7d, 14d after decompression to complete the above test contents. Results： The differences of improved Tarlov motor function grades were not statistically significant between control group and group A or B at ld after decompression （P〉0.05）. The differences of improved Tarlov motor function grades were not statistically significant between group A and B at ld, 3d, 7d of post-decompression（P〉0.05）. The improved Tarlov motor function grade test in group A was significantly improved compared with that in group B at 14d after decompression（P〈O.05）. No significant difference was found with respect to the apoptosis between group A and B（P〉0.05） at ld, 3d after decompression. The apoptosis was lower in group A and B at ld of post-decompression than control group （P〈0.05）. The difference of

关 键 词：脊髓损伤 基质金属蛋白酶2 细胞凋亡 流式细胞仪 损伤控制手术 

分 类 号：R683.2[医药卫生—骨科学] R619[医药卫生—外科学]