脂肪颗粒与生物蛋白胶联合应用预防硬膜外粘连的实验研究

Prevention from peridural fibrosis and adhesion after laminectomy by combined application of fat particle and fibrin glue

目的:探讨自体脂肪颗粒(FP)与医用生物蛋白胶(FG)联合应用预防椎板切除术后硬膜外粘连的效果.方法:90只SD大鼠随机分为5组.1组为对照组(C组),其它4组分别于L1～L2椎板切除术后在硬膜外腔放置FP(FP组)、自体游离脂肪片(FF组)、FG(FG组)及FP+FG(FPFG组).术后分别于4、8、12周对各组动物进行大体、光镜观察和计算机图像分析.结果:FPFG组硬膜外瘢痕较其它各组显著减少(P＜0.05),脂肪坏死面积比率较FP及FF组显著降低(P＜0.01),而移植脂肪中再生毛细血管数量较FP及FF组显著增加(P＜0.01).结论:自体脂肪颗粒与医用生物蛋白胶联合应用可防止脂肪颗粒流失,提高脂肪存活率,起到三维的遮挡保护作用,能有效地防止椎板切除术后硬膜及神经根周围的纤维化与粘连.

Objective:To study the effectiveness of various materials including autogenous fat particle(FP), autogenous free fat(FF),fibrin glue(FG) and the combination of FP and FG(FPFG) on prevention of peridural fibrosis and adhesion(PDFA).Method:Ninety rats were divided randomly into five groups:FP,FF,FG,FPFG and Control(C),18 rats in each group.Material above were applied to the laminectomy sites.PDFA was measured,using a double-blind protocol,at 4,8,12 weeks postoperatively by gross anatomical appearance (blunt dissection),optical microscopical evaluation and computer image analysis.Result:The results demonstrated there was statistical significance between each group at each time point(P<0.05) on above index examined except between FP and FF(P>05).For FPFG,the score of adhesion tenacity and histological assessment was lower,the scar area and adhesion/circumference of dura was less,the signal intensity of MRI with contrast is weaker than those of other groups,FP and FF,and FG was a little better than C groups.Factorial analysis of FP and FG for the scar area and adhesion/circumference of dura at 4 and 8 weeks manifested there was synergy interaction between FP and FG groups(P<0.05).The necrosis rate and the quantity of vascularization within implant fat differed significantly from each other among FF,FP,FPFG groups(P<0.01).The necrosis rate in FPFG was lowest followed by FP,and that of FF was highest.The quantity of vascularization within implant fat of FPFG was most followed by FP,and that of FF was fewest.Conclusion:Present experiment suggests that combination of FP and FG applied for prevention of peridural fibrosis and adhesion(PDFA) is more effective because of higher fat survival rate,lower fat particles running off.