聚乙交酯膜预防椎管术后硬膜外瘢痕粘连的实验研究—大体组织学改变

Experimental Study on Prevention of Epidural Fibroscar Adhesion Postlaminectomy with Biodegradable Polyglycolic Acid Membrane:Observation of Gross Morphological Histology

目的 :观察聚乙交酯 (PGA)膜对预防椎板切除术后硬膜周围粘连的作用。方法 :在新西兰兔L3 、L5部位切除椎板 1.0cm× 0 .5cm ,一缺损处在硬膜外放置PGA膜 ,另一缺损部放置明胶海绵或空白对照 ,于术后 3、6、9、12周作形态和组织学观察。结果 :大体形态观察PGA膜 3周时开始降解 ,6周时分解成较大碎片 ,9周时吸收 6 0 %～ 80 % ,12周时仅残留部分小碎片 ,硬膜外无瘢痕粘连。明胶海绵和空白对照组瘢痕粘连发生率为 88%和 10 0 %。组织学检查 :PGA膜组各时点均未见硬膜外纤维组织产生 ,硬膜与背侧组织无粘连 ,明胶海绵组 (除 3周外 )和空白对照组均产生明显的粘连。结论 :PGA膜能有效防止椎管术后瘢痕粘连。

Objective: To investigate the effect of polyglycolic acid(PGA) membrane in the prevention of extradural adhesion after laminectomy.Mehtods:1.0cm×0.5cm laminectomies were performed in 32 healthy adult New Zealand rabbits at L 3 and L 5.One of the defects was covered with PGA membrane and the other defects was filled with gelfoam or blank as a contrast,the animals were examined by evaluated grossly and histology at the 3rd?6th?9th and 12th week postoperative.Results:Grossly,the PGA membrane began to degrade at the 3rd week postoperatie.At the 6th week,it degraded into bigger pieces.At the 9th week,it was fragile and absorbed 60%～80%.At the 12th week,there were only a few small pieces left.There were no obvious difference between the group gelfoam and group contrast.Histological results showed the group PGA membrane was not found the extent of peridural fibrosis in varing intervals.The dural was not fibroscar adhesion with dorsal tissue,howerver group gelfoam and blank group all had obvious adhesion.Conclusion:The PGA membrane is useful for the prevention of scar extension into the spinal canal and prevention adhesion of scar tissue to dura after laminectomy.