带蒂脂肪片加几丁糖预防腰椎间盘突出术后硬膜外瘢痕形成

Pedicle fat grafts and chitsan on preventing postoperative epidural scar formation following lumbar disc herniation surgery

目的探讨带蒂脂肪片与几丁糖预防腰椎间盘突出术后硬膜外瘢痕形成的临床效果。方法对自2001年1月。2006年1月收治的符合纳入标准120例腰椎间盘突出症进行回顾性研究。其中随访完整者带蒂脂肪片与几丁糖组34例（A组），带蒂脂肪片组35例（B组），几丁糖组33例（C组）。结果102例获随访5～8年，平均6年6个月。术后8周各治疗组间差异无统计学意义（χ^2=0．046，P=0．87）。5年以上随访结果：3组疗效有统计学意义（χ^2=7．23，P=0．03），其中，A组与B组间差异无统计学意义（χ^2=0．289，P=0．628）；A组与C组间差异有统计学意义（χ^2=6．017，P=0．016），B组与C组间差异有统计学意义（χ^2=3．875，P=0．047）。结论单独使用几丁糖能够获得较好的近期疗效，长期随访结果显示：带蒂脂肪片能有效减少腰椎间盘突出术后硬膜及神经根周围的纤维化与粘连，带蒂脂肪片加几丁糖两者具有协同作用，较单一材料应用效果更肯定。

Objective To investigate the clinical effect of the pedicle fat grafts and Chitsan on preventing postoperative epidural scar formation after lumbar diseectomy. Methods The medical records of 120 patients with lumber disc herniation who performed a unilateral partial laminectomy and discectomy from Jan. 2001 to Jan. 2006 were reviewed. Among the patients, 34 cases were treated with fatty flap pedicled with the 3rd lumbar vessel and Chitsan （group A）, 35 eases were treated with fatty flap pedicled with the 3rd lumbar vessel （group B）, and 33 eases were treated with Chitsan （group C）. Results All of 102 patients received 5-8 years, follow-up （6 years and 6 months on average）. There＇re no statistical differences among the three groups 8 weeks after operation （χ2=-0.046 ,P =0.87）, however, therapeutic effect more than 5 years after operation showed no statistical differences between group A and group B （χ2=7.23, P =0.03 ）, but showed statistical differences between group C and any one of the other two groups. Conclusion Solo application of Chitsan has a better short-term clinical effect, however, concluded from more than 5 years follow-up, the pedicle fat grafts ean improve clinical effects of post--discectomy through reducing epidural scar formation and preventing peridural fibrosis and adhesion, the pediele fat grafts combined with Chitsan played the synergistie reaction, which is better than solo application of Chitsan and the pedicle fat grafts.