自体真皮移植预防硬膜外纤维化及粘连的实验研究

Empirical study of autogenous dermal grafts in the prevention of epidural fibrosis and adhesions

目的探讨自体真皮移植预防硬膜外纤维化及粘连的效果，为临床应用提供实验依据。方法选取5头西藏小型猪，手术切除L2、L4全椎板造成缺损，去除硬膜后方硬膜外脂肪暴露硬脊膜，切取自体真皮移植于L2椎板缺损处覆盖硬脊膜（实验组），L4椎板缺损处硬脊膜外不用任何移植物覆盖（自身空白对照组）。于术后2、4、6、8、10周全麻下股动脉放血法各处死1头动物，大体观察移植真皮存活情况及是否存在毛发生长、皮脂腺和汗腺分泌物。采用改良Robertson记分法评定硬膜外瘢痕量及粘连程度，SPSS13．0统计学软件进行统计分析。组织学观察移植真皮内皮肤附属器变化情况。结果移植真皮全部成活，与体表真皮比较明显增厚（P〈0．05）。实验组未见移植真皮毛发生长、皮脂腺囊肿和汗液囊肿形成；真皮与硬脊膜之间存在潜在的易分离平面，只有极少量瘢痕组织，粘连疏松，硬膜表面和移植真皮表皮面光滑。对照组大量的瘢痕形成，竖脊肌前方瘢痕组织严重且广泛长入硬膜外腔，与硬脊膜粘连紧密，硬脊膜从瘢痕组织上分离困难。改良Robertson记分法评分，实验组硬膜外瘢痕量及粘连程度明显低于对照组（P〈0．05）。组织学观察见毛囊萎缩、毛根坏死、皮脂腺及汗腺消失。结论自体真皮是一种具有良好的抑制瘢痕形成和物理隔离屏障作用的生物材料。自体真皮移植能有效地预防硬膜外纤维化及粘连，具有临床应用价值。

Objective To investigate the ability of auto-dermis gratis in the prevention of epidural fibrosis and adhesions, and provide reference for clinical application. Methods Five Tibet mini-pigs were used and lamineetomy was performed in lumbar 2 and 4 segment. Dura was exposed and covered with autogenous dermis grafts in lumbar 2 （the experimental group）, without grafts in lumbar 4 （the autogenous blank group）. The specimens were observed grossly and histologically at 2, 4, 6, 8 and 10 weeks postoperatively. Epidural sear amount and adhere range was evaluated by modified Robertson scoring method and analyzed by SPSS 13.0. No sear and adhesion, 0 point; small amount scar and light-range adhesion, 1 point; medium scar and midrange adhesion, 2 pionts; bulk sear ang high-range adhesion, 3 pionts. Results All grafted dermis survived and thicken obviously than dermis in body surface （P〈 0.05）. Hair growth, sebaceous gland cyst and sweat cystogenesis were not observed. A larvaceous dissection abruption plane, little cicatricial tissue and adhesions rarefaction between dermis and dura were observed in the experimental group. Massive cicatricial tissue from erector spinae filled in cavitas epiduralis was observed and dura was separated difficultly from cicatricial tissue in the autogeous blank group. Epidural scar amount and adhesion range in the experimental group was significantly lower than the blank group （P〈 0.05）. Conclusion Dermis is a kind of favourable biomaterial with restraining cicatrisation and isolation barrier. Autogenous dermis grafts has the best effect on preventing peridural cicatrisation and adhesion after laminectomy.