新型壳聚糖衍生物预防椎板切除术后硬膜外粘连的实验研究

Experimental study of a new chitosan on preventing epidural adhesion after laminectomy

目的:探讨一种新型壳聚糖衍生物——羟丁基壳聚糖对椎板切除术后硬膜外粘连的预防作用。方法:36只SD大鼠随机分为3组,2%羟丁基壳聚糖组(A组)、3%羟丁基壳聚糖组(B组)及对照组(C组),每组12只。三组大鼠行L2椎板切除术后,A、B组于硬脊膜外分别注入2ml浓度为2%、3%羟丁基壳聚糖溶液,C组旷置,然后缝合切口。术后6周取材,大体观察硬膜外粘连情况,进行Rydell分级;行免疫组织化学检测,计算羟脯氨酸(hydroxyproline,Hyp)含量;切片行HE染色,观察硬膜外瘢痕增生情况,并行成纤维细胞计数。结果:术后6周A组及B组硬膜外粘连程度均较C组轻,Rydell评分差异显著(P<0.05),而A、B组之间无显著性差异(P>0.05);三组硬膜外瘢痕组织中Hyp含量分别为0.284±0.065μg/mg、0.302±0.109μg/mg、0.963±0.188μg/mg,A、B组含量均较C组少,差异显著(P<0.05),而A、B组之间无显著性差异(P>0.05);组织学观察见A组及B组与C组比较硬脊膜外胶原增生较少,瘢痕组织结构疏松,但三组成纤维细胞计数无显著性差异(P>0.05)。结论:羟丁基壳聚糖能够有效阻隔大鼠硬膜外瘢痕组织,明显减少胶原组织增生,具有良好的预防硬膜外粘连的作用,有望成为一种新型防粘连生物医学材料。

Objective：To explore the effect of a new chitosan -hydroxybutyl chitosan on preventing epidural adhesion after laminectomy.Method：36 Sprague-Dawley rats were randomly and evenly divided into three groups,the 2% hydroxybutyl chitosan group（group A）,the 3% hydroxybutyl chitosan group（group B） and the control group （group C）.Laminectomy was performed on L2 segment in each rat.After that,the exposed duramaters in group A and B were covered respectively with 2ml 2% and 3% hydroxybutyl ehitosan solution, while in group C the exposed duramater was left uncovered.6 weeks after operation,specimens were harvested and then subjected to gross,immmunohistochemical and histological examinations to compare their therapeutic effects on epidural cicatricial tissues.Result：According to the Rydell scoring,the adhesion in group A and group B was both significantly minor than in group C （P〈0.05）,while the difference between group A and B showed no significance （P〉0.05）.The content of Hyp in group A,B and C was 0.284±0.065μg/mg,0.302± 0.109μg/mg and 0.963±0.188μg/mg respeetively with the diffierence between group C and group A and B significant （P〈0.05）.According to the histological observation ,the epidural collagenous fiber in group A and B was less than in group C.The scar tissue had loose structure.But the number of collagenoblasts in three groups showed no significant diffcrence（P〉0.05）.Conclusion：Hydroxybutyl chitosan can effectively separate the epidural sear tissue and reduce the amount of Hyp whieh is expected to be a new anti-adhesion biomaterial.