不同硬脊膜缝合修补方法预防脑脊液漏的动物实验研究

Experimental study on prevention of cerebrospinal fluid leakage by different dural suture methods in animals

目的:通过动物实验研究,探讨不同的硬脊膜缝合修补方法预防脑脊液漏的效果。方法:选用猪的脊柱作为实验对象,获取完整的硬脊膜,将硬脊膜腔一端闭合,另一端连接输液器,通过调节输液器不同高度,可以获得30、50、70、90cmH2O的压力,在硬脊膜上切开一个15mm长的切口,分别选择PDS、Vicryl、Prolene三种缝线(其中PDS缝线设为A组,Vicry缝线设为B组,Prolene缝线设为C组),各缝线包括三种规格(4-0、5-0、6-0),分别使用间断缝合、普通连续缝合及锁边缝合方法进行缝合,缝合完成后打开输液器的滴管,计算渗透率[渗透率(ml/min)=每分钟从滴管流出的水滴容积],比较不同缝合线及缝合方法对硬脊膜的闭合效果,最后在缝线周围喷洒生物蛋白胶,再测量渗透率,进行比较。结果:在动物实验研究中,A组和C组进行组内三种不同规格缝线比较,通过测量渗透率,结果差异无统计学意义(P>0.05),PDS、Vicryl、Prolene这三种缝线间比较,结果显示Vicryl 5-0比PDS 5-0和Prolene 5-0具有更低的渗透率,结果有统计学意义(P<0.05),使用Vicryl 5-0缝线分别用间断缝合、普通连续缝合及锁边连续缝合方法缝合,结果显示三种缝合方法间比较差异无统计学意义(F=1.586,P>0.05),使用生物蛋白胶后可以显著降低渗透率,对硬脊膜可以获得更好的密封效果,结果具有统计学意义(F=39.66,P<0.05)。结论:使用Vicryl 5-0缝线修补硬脊膜可以降低脑脊液漏的发生率,三种缝合方法(间断缝合、普通连续缝合及连续锁边缝合)无显著差异,硬脊膜缝合后在其表面喷洒生物蛋白胶可以显著提高硬脊膜的密封效果。

Objectives:To explore the effect of different dural suture techniques in preventing cerebrospinal fluid leakage(CSFL)through animal experiments.Methods:The spine of pig was used as an experimental object.The intact spinal cord and dura were harvested.One end of the dura cavity was closed and the other end was connected to the infusion device which could adjust the pressure by different heights(30,50,70,90cmH2O).A 1.5cm durotomy was made by using a scalpel blade,then PDS(group A),Vicryl(group B)and Prolene(group C)(4-0,5-0,6-0,expectively)were selected to close the incision.Then,the drip tube of infusion set was opened.The flow rate of the fluid was measured by counting drops per minute from the drip chamber of the reservoir.The difference of the leakage flow rate by using different types of suture and different suture methods,including continuous locked versus,interrupted suture and running suture,and the effectiveness of fibrin glue.Results:In animal studies,there was no statistical difference between using PDS 4-0,5-0,6-0 and Prolene 4-0,5-0,6-0 suture.5-0 vicryl was found to have significantly decreased leakage flow rate than 5-0 Prolene and 5-0 PDS II.There was no significant difference in the flow rate between the interrupted,running and continuous locked sutures(F=1.586,P>0.05).In most cases,leakage occurred from the needle holes around sutures.The use of sealants could significantly reduce the leakage rate(F=39.66,P<0.05).Conclusions:The using of Vicryl suture to repair the dura can significantly reduce the leakage flow rate,there is no significant difference in the flow rate between the interrupted,running and continuous locked sutures.The using of fibrin glue can improve the sealing effect of dural.