几丁糖和聚乳酸防粘连凝胶及玻璃酸钠预防硬膜外瘢痕粘连的实验研究

An Experimental Study on Prevention of Postlaminectomy Adhesion by the Use of Chitosan,Polyactic Acid Glue, and Sodium Hyaluronate

目的:观察和评价几丁糖、聚乳酸防粘连凝胶及玻璃酸钠对椎板切除模型大鼠硬膜外瘢痕粘连的干预效果,并探讨其作用机制。方法:72只成年雄性SD大鼠随机分为几丁糖组、聚乳酸防粘连凝胶组、玻璃酸钠组和生理盐水组,每组18只。行L1椎板切除术,造成0.4cm×1.0cm大小缺损,同时于硬膜外分别涂以几丁糖、聚乳酸防粘连凝胶、玻璃酸钠及生理盐水冲洗,术后常规饲养。分别于术后第4、8、12周处死大鼠,每批每组随机抽取6只大鼠取术段脊椎进行大体观察、HE染色光学切片组织学观察,评估瘢痕粘连程度,电镜观察纤维细胞结构。结果:术后4周,生理盐水组大体、组织学观察结果评分与几丁糖组、聚乳酸防粘连凝胶组及玻璃酸钠组比较,差异有统计学意义(P<0.01),几丁糖组、聚乳酸防粘连凝胶组及玻璃酸钠组间差别无统计学意义(P>0.05);术后8周及12周,聚乳酸防粘连凝胶组大体、组织学观察结果评分优于几丁糖组、玻璃酸钠组及生理盐水组(P<0.01),几丁糖组、玻璃酸钠组优于生理盐水组(P<0.01),几丁糖组优于玻璃酸钠组(P<0.01)。术后12周,电镜观察,生理盐水组纤维细胞细胞器充分,合成胶原功能完全;几丁糖组细胞器较玻璃酸钠组少,合成胶原功能较低;聚乳酸组中细胞器最少,合成胶原功能最低。结论:几丁糖、聚乳酸防粘连凝胶、玻璃酸钠对椎板切除模型大鼠硬膜外瘢痕形成均有明显抑制作用,聚乳酸防粘连凝胶预防粘连效果优于几丁糖和玻璃酸钠。

Objective：To observe and evaluate the effect of chitosan, polyaetie acid glue and sodium hyaluronate （trade name ： Sofast ） on preventing epidural adhesion after lamineetomy. Methods： Seventy - two adult male SD rats were randomly divided into 4 groups ： Group chitosan （ Group A） , Group polyactic acid glue （ Group B ） , Group Sofast （ Group C）, Group saline solution （ Group D）. All the rat models were established by undergoing L1 laminectomy with 0.4cm × 1.0cm dura mater exposed. At the same time to smear chitosan, polyaetic acid glue, Sofast and saline solution on the wound in each group. All rats were then treated with normal feeding. Six rats by random in each group were sacrificed at the 4th,8th and 12th weeks after lamineetomy to take out the spinal that had been operated on for gross observation, histological examination and electron microscope observation. Results： At the 4th week, the results from gross observation and histological examination in Group D were markedly different from those in Group A,B ,and C（ P 〈 0.01 ）, and no significant difference was noted between Group A, B,and C（ P 〉 0.05 ）. At the 8th week and 12th week,the results from gross observation and histological examination in Group B were better than those in Group A,C,and D;Group B and C was better than Group D; Group A was better than Group C （P 〈 0.01 ）. At the 12th week,electron microscope observed that the construct of fibrecell in Group D was plentiful and that the function of compose collagen was entirety; and that the situations in Group A and C was worse; and that those in Group B was the worst. Conclusion： Chitosan, polyactic acid glue, and Sofast evidently restrained the epidural adhesion after laminectomy. The effect of polyactic acid glue is greater than that of chitosan and So fast.