应用人工硬脊膜预防瘢痕粘连早期临床观察

Early Clinical Observation of Scar Tissue Preventation with Artificial Dura

目的 :介绍一种新的预防脊柱外科手术后瘢痕组织形成 ,硬膜粘连的一种方法 ,提高对椎板切除术后硬膜粘连的认识。方法 :对 17例腰椎间盘突出症椎板间开窗、间盘摘除的病人 ,术中应用美国戈尔公司生产的人造硬脊膜 ,术后 3～ 6个月行核磁共振检查瘢痕组织的生成与硬膜粘连的情况。结果 :17例应用人造硬脊膜的病人 ,3～ 6个月核磁共振示人造硬脊膜与脊髓之间无粘连 ,无瘢痕组织长入硬脊膜外空间 ,而同期手术的 14例病人未应用此人工材料 ,其核磁共振影像均可见不同程度的瘢痕组织增生 ,脊髓与瘢痕组织粘连 ,神经根周围亦有瘢痕组织包裹、环绕。结论 :人造硬脊膜有效降低了椎板切除术后瘢痕组织的产生程度 ,使病人减少了椎板切除术后瘢痕组织生成导致的疼痛 ,亦为二次手术创造了有利的条件。人造硬脊膜是一种比较理想的隔离物。

Objective:To introduce a new method to prevent the scar tissue formation and dura adhesion after operation of spinal column and deepening the understanding of dura adhesion after Laminectomy.Methods:The artificial dura mater produced by America GORE Company was used for 17 patients of lumbar intervertebral disc protrusion performed by vertebral laminas fenestration and lumbar intervertebral disc excision.In 3～6 months after operation,the condition of scar tissue formation and dura adhesion were examined by nuclear magnetic resonance or CT scan.Results:The examination of 3～6 months nuclear magnetic resonance or CT scan of 17 patients who were used the artificial dura showed that there were no adhesion between the artificial dura and spinal cord and no scar tissue grew into the space outside the dura of spinal cord.On the contrary,there were various degrees of scar tissue hyperplasia and scar tissue encapsulation and twining showed on the nuclear magnetic resonance image of 14 patients operated at same period,who had not used the artificial material.Conclusion:The artificial dura can reduce the degree of scar tissue formation effectively after laminectomy,reduces pain of patients caused by the scar tissue formation and creates favorable conditions for the second operation.The artificial dura is a kind of desirable isolator relatively.