局部应用他克莫司和丝裂霉素预防腰椎板切除术后硬膜外瘢痕粘连的比较

Comparion of topical application of tacromulis(FK506) and mitomycin C(MMC) in preventing postlaminectomy epidural adhesion

目的比较局部应用他克莫司(FK506)和丝裂霉素C(MMC)预防腰椎板切除手术后硬膜外瘢痕粘连的效果。方法 36只SD大鼠用于制作椎板切除术模型(L1椎体),并将其随机分成3组:0.1 g/L FK506组、0.1 g/L MMC组和生理盐水对照组,检测用药前后后肢运动功能评分(BBB评分)的变化。术后4周分别行大体标本观察、羟脯氨酸(HPC)含量检测和组织病理学观察。结果用药前后各组BBB评分差异无统计学意义(P>0.05),FK506组存在轻度粘连,MMC组无明显粘连,对照组形成紧密的硬膜外瘢痕粘连。FK506组和MMC组硬膜外瘢痕中HPC含量、成纤维细胞计数较对照组明显降低,且MMC组优于FK506组(P<0.05)。结论局部应用FK506可减少椎板切除术后瘢痕形成,有效预防硬膜外粘连,但MMC防粘连效果优于FK506。

Objective To compare the effect of topical application of tacromulis （FK506） and mitomycin C （MMC） in preventing postlaminectomy epidural adhesion. Methods 36 SD rats were used in the experiment to set up laminectomy model on Ll. They were divided into 3 groups randomly. Cotton pads soaked with 0. 1 g/L FK506, 0. 1 g/ L MMC and normal saline were used in control group. BBB scoring were detected before and after administration. Macroscopic specimens observation, hydroxyproline （HPC） content detection, the histopathological observation were administrated to evaluate epidural adhesion after 4 weeks. Results BBB scoring had no significant difference before and after administration （ P 〉 0. 05 ）. Mild epidural adhesion was found in FK506 group, no obvious adhesion was formed in MMC group, while severe epidural adhesion was formed in control group. The hydroxyproline content of scar and the count of fibroblasts in FK506 and MMC group were obviously less than that in control group, moreover MMC group was better than FK506 group （P 〈 0. 05 ）. Conclusions Topical application of FK506 and MMC may be a successful method of preventing postlamineetomy epidural fibrosis, meanwhile, MMC may be better than FK506.