硬膜切开减压术实施时间对急性脊髓损伤的影响  

Effects of operation time of durotomy on acute spinal cord contusion

作　　者：刘洋[1] 王文己[1] 

机构地区：[1]兰州大学第一医院骨科,甘肃兰州730000

出　　处：《西安交通大学学报（医学版）》2018年第2期237-240,244,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的探讨脊髓急性挫伤后,硬膜切开术的实施时机对脊髓损伤的影响。方法选择SD大鼠的脊髓挫伤模型,分别在脊髓损伤后立即、1、6、12h行损伤部位的硬膜切开减压术,观察对术后脊髓损伤空洞体积比、损伤长度以及神经功能恢复(后肢BBB评分)的影响。结果伤后立即及1h行硬膜切开组的动物,在术后28d时的后肢BBB评分都明显高于对照组(P<0.01),且脊髓损伤空洞比及损伤长度也明显小于对照组(P<0.01);伤后6h行硬膜切开组动物的后肢BBB评分虽然高于对照组(P<0.05),但却低于伤后立即及1h切开组(P<0.05);同样,脊髓损伤空洞比及损伤长度也小于对照组(P<0.05),但是大于伤后立即及1h切开组(P<0.05);伤后12h硬膜切开组动物的后肢BBB评分及脊髓损伤程度与对照组相比均无统计学差异(P>0.05)。结论在急性脊髓挫伤后6h内行硬膜切开减压对减轻脊髓损伤及促进神经功能恢复有较明确的效果,在损伤1h内进行硬膜切开减压,则效果更明显;伤后12h行硬膜切开减压对减轻脊髓损伤无效。Objective To study the effects of operation time of durotomy on acute spinal cord contusion.Methods Spinal cord contusion models were established in SD rats at T9 by NYU-Ⅱ impactor.Durotomy was performed immediately(group C),1 h(group D),6 h(group E)and 12 h(group F)after spinal cord contusion,respectively.Rats in group B did not receive durotomy.Open-field locomotor function was evaluated using the Basso-Beattie-Bresnahan(BBB)locomotor rating scale at days 1,3,7,14,21 and 28 after injury in order to compare damage degree of the spinal cord.The percentage of cavity volume(CV%)and lesion length were calculated by"Imagej"software using serial sections stained by hematoxylin/eosin(HE).Results The BBB score in groups C and D was significantly better than that in group B(P <0.01);CV% and lesion length were significantly lower than those in group B(P<0.01).The BBB score was higher in group E than in group B(P<0.05),but lower than in groups C and D.Similarly,CV% was lower than that in group B(P<0.05),but higher than that in groups C and D(P<0.05).No difference was found between groups F and B in the BBB score,CV%or lesion length(P>0.05).Conclusion Decompressive durotomy improved motor function recovery and reduced the damage of the spinal cord in the setting of a thoracic spinal cord contusion injury in SD rats within 6 h after injury.Durotomy 12 h after injury does not affect function outcomes or spinal cord injury after injury.

关 键 词：脊髓损伤 硬膜切开减压术 运动功能 空洞体积 

分 类 号：R651.2[医药卫生—外科学]