聚DL-乳酸生物可吸收生物膜联合丹参预防兔椎板切除术后硬膜外黏连的影像学评价

Imaging evaluation of poly-DL-lactic acid bioabsorbable biofilm combined with salvia miltiorrhiza on prevention of epidural adhesion after laminectomy in rabbits

目的探讨聚-DL-乳酸(PDLLA)可吸收生物膜联合丹参注射液、明胶海绵片预防兔椎板切除术后硬脊膜外粘连的临床效果。方法将30只新西兰大白兔随机均分为A、B、C、D、E5组。均行L5-7全椎板切除术。在术中椎板缺损处:A组采用明胶海绵片覆盖,B组采用丹参注射液+明胶海绵片覆盖,C组采用PDLLA可吸收生物膜覆盖,D组采用PDLLA可吸收生物膜膜+丹参注射液+明胶海绵片覆盖,E组(对照组)不做任何处理。术后第8周,将各组的大白兔处死,取脊柱标本,将脊柱标本行CT扫描,观察各组大白兔椎管内硬脊膜外间隙充盈程度和椎管内硬脊膜外间隙缺损程度的情况,用Microview统计软件计算单位体积内造影剂的充盈体积比。结果 B、D 2组切口愈合时间均较A、C、E 3组短(均P<0.05)。A、B、C、D 4组椎管内硬脊膜外间隙Ⅲ度充盈所占比例均明显高于E组;C、D 2组Ⅳ度充盈所占比例均明显高于A、B、E3组,而D组明显高于C组(均P<0.05)。A、B、C、E 4组椎管内硬脊膜外间隙Ⅲ度、Ⅳ度缺损所占比例均明显高于D组,A、C、D、E 4组Ⅲ度缺损所占比例均明显低于B组,A、B、C、D 4组Ⅳ度缺损所占比例均明显低于E组(均P<0.05)。B、C、D3组椎管单位体积内造影剂的充盈体积比均明显高于A、E 2组(<0.05),D组明显高于B、C 2组(P<0.05)。结论 PDLLA可吸收生物膜联合丹参注射液、明胶海绵片预防椎板切除术后硬脊膜外粘连具有良好的效果。

Objective To observe the clinic effect of Poly-DL-lactic acid bioabsorbable biofilm combined with Danshen injection and gelatin sponge slice for preventing peridural adhesion after lumbar laminectomy in rabbits. Methods 30New Zealand white rabbits were randomly divided into 5 groups ：A, B, C, D,and E groups with 6 in each group. All 5 rabbits underwent L5-7 laminectomy. In the intraoperative the laminectomy area ：there were covered with gelatin sponge tablets in group A,covered with Salvia miltiorrhiza injection and gelatin sponge slice in group B,covered with bioabsorbable PDLLA biofilm in group C and covered with PDL- LA. absorbable biofilm ＋ Salvia miltiorrhiza injection ＋ Gelfoam covered in group D,E group （control group） did not do any treatment. At the 8th week after operation,6 rabbits in each group were sacrificed. Spinal specimens were taken. CT scans were performed on the spine specimens to observing the degree of filling of extradural space in the spinal canal and the degree of intraspinal spinal extradural space defect in rabbits in each group. Microview statistical software was used to calculate the filling volume ratio of the contrast agent in a unit volume. Results The incision healing time of rabbits in group B and D was shorter than that of group A, C,and E （all P〈0.05）. In group A, B,C,and D,the percentage of third-degree filling in the spinal dura mater in the spinal canal was significantly higher than that in group E;the proportion of Ⅳ filling in group C and D was significantly higher than that in group A, B,and E. The group was significantly higher in group D than in group C （all P〈0.05）. In group A,B,C,and E,the percentage of Ⅲ - degree defect and Ⅳ-degree defect in spinal extradural space in rabbits was significantly higher than that in group D ;the proportion of Ⅲ-degree defects in groups A,C,D,and E was significantly lower than that in group B;the proportion of Ⅳ defects in groups A, B,C,and D was significantly lower than that in group E （all P〈0.05）. The filling volume ratio of contrast agent in the unit volume of the spinal canal in group B,C and D was significantly higher than that in group A and E （P〈0.05）. The group D was significantly higher than that in group B and C（all P〈0.05）. Conclusion The PDLLA bioabsorbable biofilm combined with Danshen injection and gelatin sponge slice has a excellent prevention of epidural adhesions after laminectomy.