下腰椎术后硬膜外瘢痕粘连预防的实验研究

Preventionofepiduralscaradhesionfolowinglumbspineoperation

为探讨下腰椎术后硬膜外瘢痕粘连的预防问题，实验用２４只家犬，每只做５～６处椎板缺损，将戊二醛交联人胎羊膜、冻干人胎羊膜、戊二醛交联猪腹膜、猪油随机植入椎板缺损处，并留空白对照，自体游离脂肪做标准对照。双盲法观察，１、２、３、４、６、１２周瘢痕生长及硬脊膜粘连情况。观察手段包括大体观察、组织学观察、成纤维细胞计数、计算机图像分析、脊髓诱发电位检查。结果：（１）硬膜外瘢痕源于骶棘肌创面及骨断端。（２）预防硬脊膜粘连可在两侧骨断面下硬脊膜与骶棘肌间衬垫适当阻挡物。（３）膜的衬垫要以衬垫于骨面下，与骨面很好贴附，不留空隙为宜。（４）戊二醛交联人胎羊膜能防止硬脊膜粘连，减少瘢痕向椎管内侵入。

Fourbiomaterialsincludingporkfat(PF),glutaradehydecrosslinkedporkperitonium(GCP),glutaradehydecross-linkedhumanamnion(GCA)andfreeze-driedhumanamnion(FDA)durawerecomparedfortheirabilitytopreventthedurafromadhesionin24dogs.Noncontiguouslaminec-tomieswereperformedoneachdog.Laminectomizedareaswheretheabovementioned4materialsputrandomlywereservedasexperimentalgroupswhilelaminectomizedareaswithautologousfattrans-plantsputinplacewereservedasstandardcontrolandemptycontrolwassetwiththearealeftuntreat-ed.Theformationoffibrosisandtheadhesionofthedurawereevaluatedat1,2,3,4,6,12weeksafteroperationbyusingadouble-blindprotocol.Methodsofobservationincludedgrossanatomicalevalua-tion,histologicalevaluation,computer-assistedimageanalysis,fibroblastscountingandmeasurementofSCEP.Theresultsshowed:1.Theepiduralscararosefromtherawsurfaceoferectorspinalmusclesandthebonyedgescreatedbytheprocedure;2.Putingasuitableobstructorbetweentheduraandtheerec-torspinaemusclewouldmakedurabeexemptedfromadhesion;3.Theinterpositionalmembraneshouldbetuckedinbetweenthebonyedgesincloseproximitytothebonysurfacewithoutleavinganyroom;4.GCAseemstobeeficientinpreventingduraladhesionandreducingtheinvasionofthescartissueinthespinalcanal.