干扰素/聚乳酸-羟基乙酸共聚物及壳聚糖/聚乳酸-羟基乙酸共聚物复合膜防止椎板切除后的硬膜外瘢痕粘连(英文)

Interferon/poly(lactic-co-glycolic acid)and chitosan/poly(lactic-co-glycolic acid)composite membranes for prevention of epidural scar adhesion following laminectomy

背景:应用硬膜外阻隔材料是预防椎板切除后硬膜外瘢痕粘连的一种方法,而制备既有机械阻隔能力,又有抑制成纤维细胞的能力的复合膜是其中一个重要的研究方向。目的:制备壳聚糖/聚乳酸-羟基乙酸共聚物[poly(lactic-co-glycolicacid),PLGA]与干扰素/PLGA复合膜,观察其防止兔椎板切除后硬膜外瘢痕粘连的作用。方法:大耳白兔120只行L2椎板切除,随机分为6组:对照组硬膜外不放任何物质;自体游离脂肪移植组取皮下脂肪贴于硬膜表面;透明质酸钠组将透明质酸钠1mL滴于硬膜外;PLGA膜组、壳聚糖/PLGA及干扰素/PLGA复合膜组,分别将各种膜修剪成合适大小植于硬膜外。术后2,4,6,8周处死动物,观察L2术区的瘢痕形成及与硬膜粘连的情况并评分。术后4周,透射电镜下观察成纤维细胞的超微结构。结果与结论:随着时间的延长,对照组形成较广泛的瘢痕。游离脂肪组和PLGA膜组的瘢痕量少于对照组。透明质酸组早期瘢痕形成量明显少于自体游离脂肪组和PLGA膜组,后期无显著性差异,但优于对照组。壳聚糖/PLGA膜组与干扰素/PLGA膜组硬膜外瘢痕的形成量最少,与硬膜无或轻微粘连,其作用明显优于其他各组,但两种复合膜组间差异不明显。术后4周,对照组、游离脂肪组和PLGA膜组的成纤维细胞的状态和功能明显好于壳聚糖/PLGA膜组与干扰素/PLGA膜组。壳聚糖/PLGA复合膜与干扰素/PLGA复合膜是预防椎板切除后硬膜外瘢痕粘连的有效材料。

BACKGROUND：Epidural resistance materials are an approach to prevent the epidural scar adhesion after laminectomy.A composite membrane of mechanical separation and fibroblast inhibition is promising to be widely studied.OBJECTIVE：To prepare the interferon（IFN）/poly（lactic-co-glycolic acid）（PLGA）and chitosan/PLGA composite membranes,and to observe their effects on preventing epidural scar adhesion after laminectomy in rabbits.METHODS：L2 laminectomy was performed in 120 rabbits,which were randomly and evenly divided into six groups.The control group received nothing on epidurals.In the autologous free fat group,the exposed dura was covered with subcutaneous fat.In the sodium hyaluronate group,1 mL sodium hyaluronate was dripped onto the dura.In the PLGA,chitosan/PLGA,and IFN/PLGA groups,the exposed dura was covered with one of the three membranes at a sufficient size.The animals were sacrificed at 2,4,6,8 weeks postoperatively.The scar formation and adhesion to the dura in L2 laminectomy sites were observed and scored by gross observation.At 4 weeks postoperatively,fibroblast ultrastructure was observed through the use of transmission electron microscope.RESULTS AND CONCLUSION：Widespread scars formed in the control group.The scars in the autologous free fat and PLGA groups were less compared with the control group,but there was no significant difference between these two groups.In the early stage,the scars in the sodium hyaluronate group were obviously less compared with the autologous free rat and PLGA groups,while in the later period,the difference between them was not significant,but the results from the sodium hyaluronate group were still better compared with the control group.The scars and slight adhesion to the dura were observed in the chitosan/PLGA and IFN/PLGA groups.The effect of preventing scar adhesion in these two groups was remarkably superior to that in the other groups,but there was no significant difference between these two composite membrane groups.At 4 weeks postoperatively,fibroblast morphology and function in the control,autologous free rat,and PLGA groups were better than those in the chitosan/PLGA and IFN/PLGA groups.Chitosan/PLGA and IFN/PLGA composite membranes are effective materials to prevent epidural scar adhesion after laminectomy.