聚乳酸薄膜预防腰椎间盘突出症术后硬膜外粘连的临床研究

CLINICAL STUDY OF PREVENTION OF EPIDURAL SCAR AND ADHESION WITH POLYLACTIC ACID MEMBRANE

目的 观察聚乳酸薄膜预防硬膜外粘连的临床效果。 方法 将 1998年 7月～ 2 0 0 0年 4月入院的6 2例腰椎间盘突出症患者 ,随机分成实验组 32例 ,对照组 30例 ,行椎板间开窗或椎板切除、腰椎间盘切除术。实验组在椎板间缺损区域置入 0 .1mm厚度的聚乳酸薄膜 ,对照组缺损区域未置入聚乳酸薄膜。术后 2周对局部及全身不良反应进行观察 ,6个月对患者随访并作手术节段 CT复查。 结果 术后 2周 ,实验组与对照组无局部及全身不良反应 ;体温在正常范围内 ,伤口均 期愈合 ;复查血常规及肝肾功能均在正常值范围。术后 6个月实验组 2 7例痊愈 ,4例显效 ,1例有效 ;对照组 2 4例痊愈 ,4例显效 ,1例有效 ,1例无效。两组间差异无统计学意义 (P>0 .0 5 )。CT复查显示 :实验组无硬膜外瘢痕粘连 ;对照组有不同程度的硬膜外瘢痕粘连。 结论 聚乳酸薄膜组织相容性好 ,无毒 ,能有效预防硬膜外瘢痕粘连 ,具有临床应用价值。

Objective To investigate the clinical effect of polylactic acid membrane in prevention of epidural scar and adhesion. Methods From July 1998 to April 2000, 62 patients with lumbar disc herniation were randomly assigned into two groups. All were treated surgically with discectomy by fenestration or laminectomy. One group were placed with a thin of polylactic acid membrane covering the interlaminar space(n=32). The thickness of the film was 0.1mm. The other group was blank control(n=30). After 2 weeks of operation, we observed the local and systemic reactions. After 6 months clinical symptoms were revaluated and the degrees of epidural scar and adhesion were determined by CT scans. Results After 2 weeks, we found no adverse systemic reactions in all patients. Wound healing was excellent. No abnormalities of hepatic and renal functions as well as blood for routine were found. Temperature after operation was normal. After 6 months, the curative effects were as follows in experimental group and in control group: excellent in 27 patients and in 24 patients, good in 4 patients and in 4 patients, fair in 1 patient and in 1 patient, and poor in 0 patient and in 1 patient, respectively. There are no significant difference between two groups. The CT scans showed no adhesion between the epidural scar and the dural sac in all patients of experimental group. There existed various extents of adhesion in control group. Conclusion The results demonstrate that the polylactic acid membrane can effectively prevent the epidural scar adhesion with a good biocompatibility and no toxity. Its clinical application was promising.