【作者】 李彦明；

【导师】 陈允震； 陈增海；

【作者基本信息】 山东大学 ， 骨外科， 2009， 硕士

【摘要】 目的观察可吸收性明胶海绵和生物蛋白胶联合应用在预防椎板切除术后硬膜外及神经根瘢痕黏连的作用。方法48只成年新西兰雄兔切除L6(第6腰椎)椎板,造成约12mmx6mm的硬脊膜裸露区,制作椎板切除动物模型,并探查神经根,根据应用材料不同随机分为四组:明胶海绵和生物蛋白胶组(A组)、明胶海绵(B组)、生物蛋白胶组(C组)、对照组(0.9%生理盐水)(D组)。术后每日观察动物的一般情况,第2、8周每组各处死6只,完整取出L6～L7阶段标本行大体形态观察,参考Lawson标准行黏连程度评分;经微型拉压力传感器、通过数字式电子测力仪测量神经根在在根管内的活动范围;行HE染色后于光镜下观察硬膜外成纤维细胞、炎性细胞浸润和瘢痕组织黏连的范围,根据黏连程度进行分级。结果48只新西兰雄兔全部进入结果分析。①大体观察:A组2周及8周时硬脊膜及神经根与周围的血肿、瘢痕均无明显黏连,硬膜囊及神经根均无明显受压迹象。B、C、D组2周时硬膜囊、神经根与周围的血肿轻度黏连,无明显受压;8周时硬脊膜及神经根周围的瘢痕质地变硬,黏连明显而难于分离,硬膜囊受压变形。②神经根活动范围:在2周和8周时A组均优于B、C、D组;8周时c、D组优于B组。③组织学观察:A组2周时明胶海绵和生物蛋白胶形成完整的物理屏障,保护其内的硬膜囊及神经根免受瘢痕的牵拉、黏连和压迫;8周时硬膜外无黏连,炎症反应明显减轻。B、C组2周时明胶海绵存在,成纤维细胞分泌大量胶原纤维包绕血肿;8周时残存的明胶海绵网眼内充满结缔组织,硬膜囊及神经根与周围组织黏连严重。D组各周期均见硬膜与背侧组织广泛黏连,炎症反应明显。④经SPSS13.0软件行统计学分析显示明胶海绵和生物蛋白胶联合应用组与对照组比较预防黏连效果有显著差异(P＜0.05);而明胶海绵、生物蛋白胶单独应用组与对照组间结果无显著差异(P＞0.05)。结论本实验通过可吸收性明胶海绵和生物蛋白胶联合应用在预防椎板切除术后硬膜外及神经根瘢痕黏连的研究结果表明:明胶海绵与生物蛋白胶联合应用能有效的减轻硬脊膜及神经根与周围组织的瘢痕黏连,其临床应用前景广阔;而单独应用明胶或生物蛋白胶都不能有效的减轻硬脊膜及神经根与周围组织的瘢痕黏连。更多还原

【Abstract】 Objective We want to approach the prophylactic function of absorbable gelatin sponge and bioprotein glue in prevention of epidural and nerve root scar adhesions after laminectomy.Methods We excised the L6 vertebral plates of 48 adult New Zealand male rabbits,exposing spinal dura mater by 12mmx6mm,to make vertebral plate excision model.Probe the nerve root.Then divided them into 4 groups according to different materials:gelatin sponge and bioproten glue(group A),gelatin sponge(group B),bioproten glue(group C) and saline solution(group D).We observed clinic events of the rabbits everyday.We sacrificed 6 rabbits for each group on 2 and 8 weeks after operation,took out of L6～L7 completely,then observed the morphological changes of the samples grossly,measured the adhesions level according to Lawson’ standard;measured the orbit of the nerve root by mini-rafah pressure sensor and digital electronic dynamometer; after HE staining,epidural fibroblast、inflammatory cell infiltration and the scope of scar tissue adhesions were observed,and graded in accordance with the extent of adhesions.Results All the 48 rabbits were available for analysis.①Gross observation:Spinal dura mater and nerve roots didn’t adhere with peripheral hematoma and scar at 2 and 8 weeks in group A,dural sac and nerve roots were’t compressed obviously either.Dura mater and nerve roots adhered slightly with peripheral hematoma at 2 weeks in group B、C and D,but were’t compressed obviously;The scar became harden,the adhesions were obvious and difficult to separate at 8 weeks,and the sac was compressed to deform.②Orbit of the nerve roots:Group A surpassed group B、C and D at 2 and 8 weeks;Group C and D surpassed group B at 8 weeks.③Histological observation:Gelatin sponge and bioprotein gel formed intact physic barrier to protect the dural sac and nerve root from been dragged,adhered and pressed by scar at 2 weeks in group A;And there were no epidural adhesions at 8 weeks,and the inflammatory response reduced Significantly.The gelatin sponge still existed at 2 weeks in group B and C,and the hematoma was surrounded by lots of collagen fibers secreted by fibroblasts;Residual gelatin sponge filled mesh of connective tissue at 8 weeks,dural sac and nerve roots adhered seriously with surrounding tissue.In group D,dura mater adhered extensively with dorsal tissue,and the inflammatory reaction was obviously.④Statistical analysis with SPSS13.0 found that there were significant deviations between Group A and other groups(P＜0.05); but no significant deviation between Group B、C and D(P＞0.05).Conclusion In this experiment we use absorbable gelatin sponge combined with bioprotein gel to prevent epidural and nerve roots adhesions after laminectomy indicated that,gelatin sponge combined with bioprotein gel can reduce epidural and nerve roots adhesions with surrounding scar obviously,and the clinical application prospects is bright;But if use gelatin sponge or bioprotein gel separately,it will do no good.更多还原