防粘连膜在腰椎间盘突出症手术中应用的临床效果

Clinical effect of polylactic acid membrane in the surgery of lumbar disc herniation

目的探讨防粘连膜（聚乳酸）是否能够减少瘢痕面积和/或改善患者腰椎间盘突出症术后的临床结果，以及硬膜瘢痕和腰椎间盘突出症术后复发疼痛之间的关系。方法72例行腰椎间盘突出症手术的患者随机分为两组，其中38例患者术中使用防粘连膜（防粘连膜组），34例患者作为对照组。两组患者在术后12个月行MRI检查，用来评价瘢痕的大小、位置和进展情况。利用数字分级法评价术前和术后12个月的下肢疼痛严重程度；用改良Macnab量表对患者临床结果进行评分。结果防粘连膜组9例（23.7%）术后瘢痕组织对神经根有影响，对照组为16例（47.1%），差异有统计学意义（χ2＝4.326，P＝0.038）。两组瘢痕评分比较差异有统计学意义（Z＝2.340，P＝0.019），但是两组之间下肢疼痛程度没有明显不同（t值分别0.687、1.014、0.426和0.000，P值分别为0.532、0.324、0.675和1.000）。两组改良Macnab分级评价也没有统计学差异（χ2＝1.202，P＝0.273）。结论腰椎间盘突出症手术中应用防粘连膜能够减少瘢痕，但是没有明显改善临床结果。

ObjectiveTo investigate whether the polylactic acid （PLA） membrane can reduce the scar size and or improve the clinical outcome of the patients after lumbar disc herniation surgery, and the association between peridural scarring and recurrent pain after lumbar disc herniation surgery.MethodsSeventy-two patients treated with lumbar disc herniation surgery were collected and randomly divided into two groups, including 38 cases were treated with PLA membrane, and 34 cases as the control group.All patients underwent MRI at 12 months after surgery for grading the size, location and development of the scar.NRS was used to assess the severity of lower limb pain before and 12 months after surgery.The modified Macnab scale was used to assess the clinical outcomes of the patients. ResultsFor 9 cases（23.7%） in the PLA membrane group, the scar tissue had an effect on the nerve root, while 16 cases（47.1%） in the control group experienced the same, the difference was statistically sigificant （χ2=4.326, P=0.038）. There was significant difference in scar score between the two groups （Z=2.340, P=0.019）, but there was no significant difference in leg pain degree between the two groups （t=0.687, 1.014, 0.426, 0.000, P=0.532, 0.324, 0.675, 1.000）. There was no significant difference between the two groups in modified Macnab classification grading （χ2=1.202, P=0.273）.ConclusionPLA membranes used in lumbar disc herniation surgery could reduce peridural scar formation, but it does not significantly improve the clinical results.