【作者】 张超；

【导师】 吕国华；

【作者基本信息】 中南大学 ， 脊柱外科， 2010， 硕士

【摘要】 目的：本课题通过建立单节段(L1)环椎管脊椎截骨脊髓短缩动物模型,研究脊髓短缩对脊髓功能及血流的早期影响,从而对脊椎截骨的安全范围进行初步的动物实验研究,为临床截骨矫形手术提供一定的参考。方法：在动物实验中,选取成年雄性大耳家兔25只,体重2±0.4kg,体长35±5cm。将25只白兔随机分为5组,每组5只。3%的苯巴比妥耳缘静脉注射麻醉(30mg/kg)。A组为对照组,麻醉后行后路手术显露Ll的椎板及椎体,行环椎管脊椎截骨术,截骨后不压缩。B、C、D、E组为实验组(环椎管脊椎截骨脊髓短缩组),分别于麻醉成功后,通过后路手术行环椎管脊椎截骨。完成截骨后,分别压缩L1椎体总高度的25%、50%、75%、100%,并用高强度塑料线予以固定。观察指标：测量不同脊柱短缩程度下硬膜囊形态改变以评价硬膜皱缩程度。6h后用Jacobs分级,Reuters评分评价运动感觉功能,后将动物处死,行明胶墨汁血管灌注,切片观察并分析评价脊柱截骨节段脊髓内血容量,后取伤段脊髓切片,行组织病理学检查。结果：除A组,D组及E组各1只实验动物因手术原因死亡外,各组实验对象均完成实验测试项目。1、各组自身对照：迂曲最大处硬膜囊横径和硬膜囊矢状位迂曲角在C、D、E组有显著性差别(P<0.01),手术后6小时Jacobs分级在C、D、E组有显著性差异(P<0.05), Reuters评分在B、C、D、E组均有显著性差异(P<0.05)。2、组间对比：A组和B组的迂曲最大处硬膜囊横径、硬膜囊矢状位迂曲角、Jacobs评级、Reuters评分和SCBF均无显著性差异(P>0.05),其余脊髓各组间各指标均有显著性差异(P<0.05)。3、相关性分析：硬膜囊横径、矢状位迂曲角改变及SCBF变化均与术后感觉运动评分呈显著相关(r=0.955,P<0.001；r=0.848,P<0.001；r=-0.869,P<0.001)。硬膜囊横径、矢状位迂曲角改变与SCBF变化也呈显著相关(r=-0.946,P<0.001；r=-0.997,P<0.001)。4、病理学检查见脊髓损伤以水肿为主,神经元细胞肿胀,细胞核皱缩,周围水肿,神经纤维排列无规则,并见大片出血。随着脊髓短缩固定的距离增大,脊髓水肿面积越大,程度越重。结论：1、通过后路手术建立环脊椎截骨脊髓短缩模型是可行的,实验结果也可靠。2、在兔脊髓短缩模型中,脊髓的短缩会造成脊髓功能的损伤和脊髓血流量的下降。3、脊髓功能的损伤与脊髓短缩程度呈正相关,与脊髓血流量呈负相关。4、脊髓血流量与脊髓短缩程度呈负相关。5、在兔脊髓短缩模型中,规则的L1节段环椎管脊椎截骨的安全临界值为椎体总高度的50%更多还原

【Abstract】 Objective:To establish a circumspinal vertebrectomy animal model of spinal cord shortening by the 1st lumber body vertebrectomy, and investigate the acute effects of spine shortening on the spinal morphous, function and blood flow.To make contribution to the security of vertebral osteotomy by researching the safe limits of spine column shortening.Methods:25 male rabbits were randomly divided into five groups, the mean weights were 2±0.4kg and the mean lengths were 35±5cm.After general anesthesia and local anesthesia, Group A was the control group, which undergoing the 1st lumber body circumspinal vertebrectomy without docking. Group B,C,D,E were experimental groups, with the 1st lumber body circumspinal vertebrectomy. Then the two ends of osteotomy were docked different percent of lumber body length.It is grouped by docking 25%、50%、75%、100% percent of the 1st lumber body length.Target:After total vertebral osteotomy of L1,we performed spinal column shortening and measured the diameter and length of spinal cord,the angle of the spinal sagittal circuity in different percent of shortening. Jacbos grade and Reuters score were recorded 6 hours after surgery. Then the animals were executed. Blood vessels casting preferred to the harvesting of spinal cord samples. The micropictures of the spinal slides were acquired with the aid of picture collecting system. Then it was ready to obtain the data of average vessel area of each group, which is calculated via a picture analying system. Then studied the H-E slides in pathology.Results:Three animals were excluded in group A, D and E respectively because of the accident of operation.1.Self control in every group:diameter of spinal cord and sagittal circuity existed statistic significance in group C,D and E(P<0.01),after 6 hours’ observation, there were no statistic significance in the Jacobs grade between group A and B(P> 0.05),and existed statistic significance in group C,D,E(P<0.05).There were statistic significance in Reuters scores in group B, C, D, E.2.Group control:the diameter and the sagittal circuity of spinal cord, Jacobs grade, Reuters scores and SCBF between group A and B did not exist statistic significance(P>0.05),others had statistic significance(P<0.05).3.Correlations:the diameter, sagittal circuity and SCBF were all statistically correlated with Reuters scores(r=0.955,P<0.001;r=0.848,P<0.001; r=-0.869,P< 0.001).The diameter and sagittal circuity were correlated with SCBF(r=-0.946,P< 0.001;r=-0.997,P<0.001)4.The manifestation of histopathology was swelling neurons, shrinking nucleus, irregularly nervous fibers. The longer distance of the spinal is docked the larger area of the neurons swell.Conclusion:1.Animal model of spinal shortening is successful with posterior total osteotomy of vertebra and internal fixation. It is feasible and reasonable.2. Shortening of spine will damage the function and blood flow of spinal cord3.The damage of spinal cord function has positive correlation with shortening of spine, and has negative correlation with SCBF4.SCBF has negative correlation with shortening of spine5.The safe limit of spine shortening in L1 is about 50% of its total height.更多还原