角蛋白人工腱膜预防全椎板切除术后硬脊膜黏连

An experimental study on prevention of dura mater spinalis adhssion after laminectomy by using keratin substance (KS) artificial fasciae

[目的]探讨角蛋白(keratin substance,KS)人工腱膜材料用于预防全椎板切除术后硬脊膜黏连的效果。[方法]Wistar大白鼠60只,随机分3组,每组20只,咬除T12全椎板,造成2mm×8mm大小的椎板缺损,加入不同处理因素,A组空白对照组;B组人工腱膜组;C组自体腱膜组。术后2、4、8,12周处死动物,各时间点大体观察采用Rydell瘢痕黏连程度评级标准评分。完整取出T12节段,包括椎旁肌。经HE染色后,镜下组织学观察采用改良Nussbaum标准行评分。同时切取2,4、8、12周人工腱膜组硬膜外瘢痕组织进行透射电镜观察。所测数据行Kruskal-Wallis秩和检验,取α<0.05作为统计显著差异的标准。[结果]KS人工腱膜材料无毒性和排异反应A组的Rydell评分,改良Nussbaum评分高于B、C组(P<0.05),B组C组比较无差别(P>0.05)。B、C组与对照组比较,均能够明显减少椎板切除术后的硬膜外瘢痕形成。[结论]硬膜外瘢痕黏连主要来自硬膜后方的血肿和成纤维细胞(fibroblast,FB)的增殖。KS人工腱膜具有良好的组织相容性,无局部及全身的不良反应,具有良好物理屏障作用。将KS人工腱膜放置在椎板缺损处,能够有效的防止纤维组织侵入椎管,预防硬膜外瘢痕黏连。在动物实验中,KS人工腱膜能够安全有效的预防椎板切除术后硬膜外瘢痕黏连。

[Objective] To study the effect on prevention of dura mater spinalis adhesion after laminectomy through an experiment by using keratin substance （KS） artificial fasciae. [Method] Sixty rats were randomly divided into three groups, each had 20. In all rats, total laminectomy were performed at T12 levels led to the defects of 2 mm x 8 mar The group A were sutured direct- ly, which was regarded as control group; covered with artificial fasciae in group B; with self - faeiae in group C. The animals were killed at the 2nd, 4th, 8th, 12th week after operation respectively, and macroscopy assessment was done with the help of the Rydell Criterion. The spine segment of T12 was removed en bloc including the paraspinal tissue, and all specimens were stained with hema- toxylin and ensin. Improved Nusshaum Criterion was used for the following optical microscopy assessment. Transmission electron microscopy was performed on posterior epidural scar obtained from group - B at the 2nd, 4th, 8th, 12th week after operation respectively. The nonparametrie Kruskal -Wallis test was used to determine the differences between the three groups, and a P value of 〈0.05 was considered statistically significant. [Result] The use of the KS artificial fasciae caused no adverse effects. According to the Rydell and improved Nusshaum Criterion A - group was statistically significant difference from B and C - group （ P 〈 0. 05） . However, no significant difference between group B and C was observed （P 〉 0. 05 ） . So compared to the control group, KS artificial fasciae and self - fasciae significantly reduced the formation of epidural fibrosis after laminectomy. [ Conclusion ] KS artificial fasciae have the best biological compatibility with the tissues with no adverse effects. The posterior hematoma and fibroblast （FB） are the main source of the epidural fibrosis. As placement of KS artificial fasciae over the laminectomy defect in rats could provide a physical barrier against invasion of fibrous tissue into the vertebral canal, and peridural fibrosis after laminectomy would be effectively prevented. KS artificial fasciae is safe and effective in limiting the direct contact by the posflaminectomy epidural fi brosis in rats.