应用冻干羊膜进行的硬脑膜修补

Freeze-dried amniotic membrane for repair of dural defects

背景:羊膜在眼科领域的应用比较普遍,许多研究表明羊膜移植并不引起急性免疫排斥反应,这提示其可以作为修补硬脑膜缺损的安全材料。目的:探讨羊膜作为硬脑膜修补材料的可能性。方法:将豚鼠颅顶部冠状缝后、矢状缝两侧开骨窗。在右侧骨窗下切除硬脑膜,缺损处用冻干羊膜修补。左侧骨窗下切除硬脑膜后再将切下的硬脑膜修补复位,做为对照。分别在术后第15,30,60,90天处死,取修补部位脑膜标本,苏木精-伊红染色,进行组织学观察。结果与结论:术后所有动物行为无异常,皮肤切口如期愈合,无感染、无皮下积液、无脑脊液漏。植入物逐渐被降解并被一层结缔组织覆盖,修补部位与大脑表面无粘连。术后15d较多散在的成纤维细胞出现在修补材料内。术后30d部分修补材料消失,修补材料中心部位纤维结缔组织增生,未见炎细胞浸润。术后60d修补材料大部分消失,被增生及轻度变性的纤维结缔组织替代,周围见少量的异物巨细胞。术后90d修补材料呈胶原变性,其周围见骨化组织及变性的纤维结缔组织,未见炎细胞浸润。动物实验证明冻干羊膜是一种安全、有效的硬脑膜修补材料。

BACKGROUND：Amnion has been widely used in ophthalmology.Numerous studies have suggested that amnion transplantation did not induce acute immunologic rejection.These indicated that amnion transplantation can be used as a safe material for repair of dural defects.OBJECTIVE：To study the probability of freeze-dried amniotic membrane（FDAM）as a dural substitue.METHODS：Each of the guinea pigs underwent bilateral parietal craniectomy behind the coronal suture and beside the midline to expose the dura.On the right side,a piece of dura mater was removed.The dural defect was covered with a piece of FDAM.The exposed dura on the left was cut and sutured itself as control.The animals in each group were sacrificed at 15,30,60 and 90 days after operation,respectively.The implants were harvested and stained with hematoxylin-eosin,and histologically analyzed.RESULTS AND CONCLUSION：After operation,the behavior of all guinea pigs remained completely normal.The wound healing was achieved in all cases.No wound infection,subcutaneous effusion or cerebrospinal fluid（CSF）leakage occurred.The graft was degraded gradually and covered with a sheet of connective tissue.Dural defects repaired with FDAM showed no adhesions to the brain surface.15 days after operation,plenty of scattered fibroblasts appeared in the dural substitute.30 days after dural graft implantation,parts of the implant disappeared;meanwhile the hyperplasia of fibrous connective tissue took place in the center part of the dural substitute,without the infiltration of inflammatory cells.60 days after implantation,a majority of the dural graft was degraded,substituted by fibrous connective tissue which was of hyperplasia and low-grade degeneration,surrounded by a small quantity of giant cells.90 days after operation,colloidal degeneration happened in the dural substitute,surrounded by ossification tissue and the degenerated fibrous connective tissue.The inflammatory cells were not discovered.The animal experiment proves FDAM to be a safe and applicable dural substitute.