缝合和粘合两种方法修复山羊腰椎间盘纤维环缺损  

Suturing and bonding for repair of annulus fibrosus defects in goats

作　　者：王宇鹏[1] 银和平[1] 吴一民[1] 李树文[1] 杜志才[1] 白明[1] 孟格栋[1] Wang Yu-peng;Yin He-ping;Wu Yi-min;Li Shu-wen;Du Zhi-cai;Bai Ming;Meng Ge-dong(Department of Spine Microsurgery,the Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古医科大学第二附属医院微创脊柱外科,内蒙古自治区呼和浩特市010030

出　　处：《中国组织工程研究》2018年第26期4156-4161,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81260287);内蒙古自治区自然基金(2014MS0855)

摘　　要：背景:目前,切除椎间盘后绝大多数不予以行纤维环修复,这是导致术后椎间盘再次突出的重要原因之一。目的:探讨缝合法及医用纤维蛋白粘合剂法修复山羊腰椎间盘纤维环缺损的效果。方法:取6只6月龄山羊的L_(1/2)-L_(6/7)椎间盘,共36个椎间盘,随机分为3组,每组12个椎间盘。麻醉下钝性剥离山羊肌肉至椎间盘纤维环,显露L_1-L_7椎体,用小圆刀在各椎间盘分别做切长4 mm平行于终板的纤维环切口,髓核钳抓取少量髓核(约0.1 g),按术前随机选中的间盘分别进行纤维环切口缝合1针(缝合组)、粘合剂粘合(粘合组);对照组不作处理。术前及术后12周拍腰椎X射线片及MRI,计算腰椎间盘高度指数,评价腰椎退变情况。术后12周处死山羊,对缺损处行光镜和透射电镜观察。结果与结论:(1)术后12周椎间盘高度指数缝合组>粘合组>对照组;(2)腰椎MRI T2WI改良Pfirrmann评分缝合组<粘合组<对照组;(3)组织学Masuda退变评分缝合组<粘合组<对照组;(4)缝合组修复处细胞超微结构优于粘合组、对照组,粘合组优于对照组;(5)结果说明,直接缝合法及医用纤维蛋白粘合剂均可有效修复纤维环缺损,且直接缝合法优于粘合法。BACKGROUND： At present, there is a lack of effective strategies that deal with annulus fibrosus defects in a majority of cases undergoing lumbar discectomy, which is one of the important causes of postoperative relapse of lumbar disc herniation. OBJECTIVE： To explore the effects of direct suturing and medical fibrin bonder for annulus fibrosus defects in goats undergoing resection of intervertebral discs. METHODS： L1/2-L6/7 samples （36 lumbar vertebrae） from six goats aged 6 months were randomized into three groups （n=12 per group）： direct suture group, bonding group and control group （with no intervention）. An annular incision of 4 mm in length was made on the disc using a circle cutter. A small amount of nucleus pulposus （about 0.1 g） was taken from each sample followed by direct suturing, bonding and no treatment in corresponding groups. X-ray and MRI observation of the lumbar vertebra was performed preoperatively and 12 weeks postoperatively. Height index of the lumbar intervertebral disc （DHI） was calculated to evaluate the lumbar degeneration. The goats were sacrificed at 12 weeks postoperatively and the defect sites were observed using light microscope and transmission electron microscope. RESULTS AND CONCLUSION： The DHI values in three groups at 12 weeks postoperatively were ranked as follows： direct suturing group 〉 bonding group 〉 control group. Lumbar T2WI MRI modified Pfirrmann grade was ranked as follows： direct suturing group 〈 bonding group 〈 control group. Histological Masuda degeneration grade was ranked as follows： direct suturing group 〈 bonding group 〈 control group. Performance of cell ultrastructure at repair site was ranked as follows： direct suturing group 〉 bonding group 〉 control group. To conclude, both direct suturing and fibrin bonder can effectively repair annulus fibrosus defects, and moreover, direct suturing is superior to bonding in the repair effect.

关 键 词：纤维环修复 山羊 缝合 粘合剂 椎间盘高度指数 组织构建 

分 类 号：R318[医药卫生—生物医学工程]