肉眼和电镜观察聚-DL-乳酸可吸收生物膜联合丹参预防硬膜外粘连的效果

Effect of using PDLLA absorbable compound biomembrane and salvia miltiorrhiza for preventing peridural adhesion after laminectomy in rabbits by salvia naked eye and electron microscope

目的观察聚-DL-乳酸(PDLLA)可吸收生物膜联合丹参预防腰椎术后硬膜外粘连的效果。方法将60只新西兰白兔随机均分成5组,施以L5-L7全椎板切除术,A组放置明胶海绵片,B组明胶海绵片+丹参注射液,C组PDLLA可吸收膜,D组明胶海绵片+丹参注射液+PDLLA可吸收膜,E组空白对照组不作特殊处理,于术后2周、4周、8周、12周分别行肉眼大体观察、电镜观察瘢痕生长及硬膜外粘连情况。结果 B组、C组和D组有非常明显防粘连效果,与E组及A组之间存在显著性差异(P<0.05),虽然B组,C组和D组之间在防粘连效果方面无显著差异(P>0.05),但D组的防粘连效果更为突出,直到12周时电镜下成纤维细胞和胶原纤维仍呈现生长缓慢,排列紊乱和结构疏松的镜像。结论丹参+PDLLA可吸收膜有很好的三维防粘连效果,可作为理想的预防硬膜外粘连材料。

Objective To observe the effect of using poly-DL-lactic acid （PDLLA） compound biomembrane and salvia mihiorrhiza for preventing peridural adhesion after lumbar laininectomy in rabbits. Methods 60 New Zealand rabbits were averagely divided into 5 groups for this study,which had been executed total laminectomy at the L5-L7 levels and covered and filled into lami- na defect by the gelatin sponge （Group A）,the gelatin sponge ＋ the salvia miltiorrhiza injection （Group B）,the PDLLA compound biomembrane（Group C） and the gelatin sponge ＋ the salvia miltiorrhiza injection ＋ the PDLLA compound biomembrane（Group D）, respectively. There was no mem-brane being used in the contrast group （Group E）. Gross naked eye and electron microscope observation were performed to evaluate the growing rate of scars and the degree of peridural adhesion at 2 weeks,4 weeks,8 weeks and 12 weeks after operation,respectively. Results There were significantly anti-adhesion effect in the B,C and D groups,and there was significant difference compare with the E group and the A group（P〈0.05）, although there were no significant difference among the B, C, D groups （P〉0.05）, but in the D group,it has more excellent anti-adhesion ,the fibroblasts and the collagen fibers was still observed slow growth,disorganized and loose by electron microscope until 12 weeks after operation. Conclusion The salvia mihiorrhiza＋the PDLLA compound biomembrane can achieve excellent three-dimensional anti-adhesion effect,it can be used as an ideal material for prevention of epidural adhesions.