聚乙交酯膜预防椎管术后硬膜外瘢痕粘连的实验研究-大体影像学改变  

EXPERIMENTAL STUDY ON PREVENTION OF EPIDURAL FIBROSCAR ADHESION POSTLAMINECTOMY WITH BIODEGRADABLE POLYGLYCOLIC ACID MEMBRANE:OBSERVATION OF GROSS MORPHOLOGY IMAGOLOGY

作　　者：王伟[1] 黄英[1] 刘朋[1] 齐进如[1] 郝花[1] 

机构地区：[1]武警北京总队医院骨科,100027

出　　处：《中国现代医学杂志》2003年第4期15-19,共5页China Journal of Modern Medicine

基　　金：武警部队 2 0 0 0年卫生专业立项基金资助项目 (2 0 0 0 0 0 3 )

摘　　要：目的 :观察聚乙交酯 (PolyglycolicPGA)膜对预防椎板切除术后硬膜周围粘连的作用。方法 :健康成年新西兰兔 32只 ,在L3 ,L5部位切除椎板 1.0cm× 0 .5cm一缺损部位在硬膜外放置聚乙交酯膜 ,另一缺损部放置明胶海绵或空白对照 ,分别于手术后 3,6 ,9和 12周进行大体形态 ,CT和B超观察。结果 :大体形态观察PGA膜 3周时开始降解 ,6周时分解成较大碎片 ,9周时吸收 6 0 %～ 80 % ,12周时仅残留部分小碎片 ,硬膜外无瘢痕粘连。明胶海绵和空白对照组无明显差异 ,瘢痕粘连发生率为 88%和 10 0 %。CT观察 :静脉增强造影前后明胶海绵组和空白对照组硬膜外组织CT值各个周期均比同一周期的PGA膜组为高。三种方法造影前、造影后各期所测CT值同期比较 ,经方差分析 ,PGA膜组与明胶海绵组及空白对照组之间存在明显的差异(P <0 .0 0 1)。明胶海绵组与空白对照组造影前后所测CT值同期比较经t检验 ,无明显差异 (P >0 .0 5 )。B超提示 :PGA膜组各期椎管边缘清晰整齐 ,明胶海绵及空白对照组椎管内密度增高 ,有强回声团 ,椎管后缘不整齐。结论 :PGA膜能有效防止椎管术后瘢痕粘连。Objective:To investigte the effect of polyglycolic acid (PGA) membrane in the prevention of extradural adhesion after laminectomy. Methods:We performed 1.0cm×0.5cm laminectomies in 32 healthy adult New Zealand rabbits at L 3 and L 5. One of the defects was covered with PGA membrane and the other defects was filled with gelfoam or blank as a contrast. The animals were examined by CT scanning, B mode ultrasound and evaluated grossly at the 3rd,6th, 9th and 12th week postoperatively. Results:Grossly, the PGA membrane began to degrade at the 3rd week postoperatively. At the 6th week, it degraded into bigger pieces. At the 9th week, it was fragile and absorbed 60%～80%. At the 12th week,there were only a few small pieces left. There were no obviously different between the group gelfoam and group contrast. The CT scanning showed that the CT value in the group gelfoam and group contrast was higher than that in the group PGA membrane anteroposterior venography in the same intervals ( P <0.001). There was no difference in CT value between group gelfoam and group contrast by t-test( P >0.05). In the group PGA membrane, the CT Value was not significantly different among the varied intervals or anteroposterior venography.B mode ultrasound showed that the group PGA membrane in varied intervals margin of laminec tract was clear and regular;the density of group gelfoam and blank was higher in the intraspine with strong echo, the posterior surface of intraspine was irregular. Conclusion: The PGA membrane is useful for the prevention of scar extension into the spinal canal and prevention adhesion of scar tissue to dura after laminectomy.

关 键 词：聚乙交酯膜 椎板切除术 硬膜周围粘连 明胶海绵 硬膜外瘢痕粘连 B超 

分 类 号：R687[医药卫生—骨科学]