硬脊膜切开与低温灌洗联合应用在保护脊髓功能中的价值  

The value of the durotomy and the hypothermal irrigation on pretecting spinal cord function

作　　者：王秀会 王子平 许国祥 顾伟民 陆跃刚 程琳玲 

机构地区：[1]上海市周浦医院,上海201318 [2]上海市免疫研究所,上海200004

出　　处：《中国临床康复》2002年第18期2718-2719,I001,共3页Chinese Journal of Clinical Rehabilitation

基　　金：上海市南汇区科委资助(NKFG00-005)

摘　　要：目的研究和探讨联合应用硬脊膜切开和低温灌洗对损伤脊髓的保护性作用。方法96只家兔,随机平均分为4组(A、B、C、D)。全部动物行背侧显露T12～L1段硬脊膜,B、C、D、组均按Allen有氏法于暴露的硬脊膜背侧施54J势能造成脊髓损伤,尔后B组:即刻缝合切口;C组:单纯低温灌洗治疗;D组:硬脊膜切开+低温灌洗治疗。进行伤段的脊髓含水量和细胞凋亡的检测,组织病理学观察,后肢神经功能测定等。结果D组术后各时相指标均优于B组同时相(P<0.01),C组伤段脊髓水肿、细胞凋亡率和后肢神经功能测定值与B组同时相相比分别在伤后24h、72h、7d及以后的时相上无统计学意义(P>0.05)。C、D两组间的病理学变化在伤后24h相近,但至伤后7d、3周时C组的组织变化持续转差。结论硬脊膜切开与低温灌洗的联合应用能够减轻损伤段脊髓的组织学变化并可促进神经功能的恢复。Objective To evaluate th e pretective effects o f durotomy and hypothermal irrigati on on neurofunction a fter spinal cord injury(SCI ),so to expound its mechanism.Methods Ninety-s ix rabbits were divided int o four groups randomly.Dorsal spinal cord of T 12 ～L 1 were exposed,then,acute spinal cord inj ury(ASCI )at the level of L 1 according to Allen' s(impact power,54gcm)except group A,and were pro-cessed as follow:group B:treated nothing;group C:hypothermal only;group D: durotomy and irrigation.Mean while the changes of hind legs of neurofunction,p athological changes,apoptosis rate and spinal cord wa ter content were observed .Results Compared with group B,spinal cord water content and apoptosis rate co u ld be reduced,the neurofunction cou ld be increased at every time phases i n group D(P<0.01～0.05),while the group C was not at long term a fter SCI (P>0.05).Conclusion These data show that unitedly use the durotomy a nd hypothermal can markedly reduce the pathologica l changes of spinal cord and improve t he recovery of neurofunction.

关 键 词：硬脊膜切开 脊髓损伤 脊髓水肿 并发症预防 神经功能 

分 类 号：R651.2[医药卫生—外科学]