羊膜预防硬膜外粘连的初步研究

Primary Study on Prevention of Epidural Adhesion with Amniotic Membrane

目的:观察羊膜预防椎板切除术后硬膜外粘连的作用,寻求预防硬膜外粘连的有效材料和方法。方法:制备椎板切除模型兔60只,依术前随机分组,分别在硬膜外覆盖羊膜(AM组)、几丁糖膜(CHS组)、空白对照组不做任何覆盖(CON组)。于术后2、4、8、12周每组分别处死5只动物,对标本做大体解剖及组织学观察。结果:CON组暴露的硬膜发生广泛粘连,硬膜外腔几乎消失;AM组和CHS组硬膜外瘢痕稀少,硬膜表面光滑,硬膜外形成潜在腔隙,维持了硬膜外的有效空间。不同时间段三组间粘连度评分以AM组最低,CHS组次之,CON组最高,组间比较有显著性差异(P<0.05)。结论:羊膜能预防硬膜外瘢痕向椎管内延伸,防止硬膜外粘连,是一种能有效预防硬膜外粘连的生物相容性材料;几丁糖膜亦显示了一定的预防硬膜外粘连作用。

Objective：To oberve the role of amniotic membrane in the prevention of epidural adhesion after laminectomy and find out effective method and material to prevent it. Methods： Laminectomy was performed in the lumbar 5 sector of 60 rabbits, and the exposed dura mater was covered with amniotic membrane（ group AM）, chitosan membrane（ group CHS）, and no covering in the control group（group CON） respectively. Five animals in each group were sacrificed at 2, 4, 8, 12 weeks after laminectomy. The specimens were prepared for gross and histological study. Results： It was revealed that the adhesion of the dura mater to scar tissue occurred to the entire exposed surface at the control group, and the extradural space had almost disappeared. While in the groups AM and CHS less adhesion developed, the dura mater was smooth and in the epidural cavity, the epidural space well preserved. Adhesion degree evaluation in group AM was lowest while in group CON highest, the suppression of epidural scar formation was more obvious in the group AM than that in the group CHS, and there was statistical difference（ P〈0.05）. Conclusion： After laminectomy amniotic membrane is an effective biocompatible material in preventing epidural adhesion, and chitosan membrane has also showed certain effect.