应用聚氨基酸膜预防术后椎管粘连的实验报告

１８只成年白兔平均分三组。椎扳切除后，实验组在硬膜外覆盖聚氨基酸膜，硅胶组用硅胶膜覆盖，空白组无覆盖物。术后３０ｄ、６０ｄ处死动物。结果显示：实验组及硅胶组的硬脊膜均光滑无增厚，硬膜外间隙未见新生纤维组织增生或粘连。聚氨基酸膜于１个月降解吸收，形成硬膜外＂空隙＂，硅胶则不吸收。空白组的硬脊膜增厚，硬膜外纤维组织增生或粘连明显，硬膜外间隙消失。因此，可降解的聚氨基酸膜能有效地预防术后椎管瘢痕粘连的形成，又不存留异物，是一种较理想的生物材料。     

带蒂筋膜脂肪片修复椎管联合持续引流预防腰椎管狭窄症并硬脊膜损伤术后瘢痕粘连的效果观察

目的比较带蒂筋膜脂肪片修复椎管联合持续引流与硬脊膜修补联合透明质酸钠注射预防腰椎管狭窄症并硬脊膜损伤术后瘢痕粘连的效果。方法回顾性分析自2015-05—2018-05采用手术治疗的64例腰椎管狭窄症并硬脊膜损伤,32例采用带蒂筋膜脂肪片修复椎管联合持续引流预防硬脊膜粘连(观察组),32例采用硬脊膜修补联合透明质酸钠注射预防硬脊膜粘连(对照组)。比较2组手术时间、术中出血量、切口愈合时间、脑脊液漏发生率、并发症发生率,以及术后12个月狭窄节段椎管矢状径、狭窄节段硬膜囊面积、疼痛VAS评分、JOA评分。结果观察组与对照组手术时间、术中出血量差异无统计学意义(P0.05);观察组切口愈合时间较对照组短,差异有统计学意义(P 0.05)。观察组术后无并发症发生,对照组术后7例脑脊液漏,4例切口深部感染,1例假性硬脊膜囊肿。与对照组比较,观察组术后脑脊液发生率、并发症发生率较低,术后12个月狭窄节段硬膜囊面积较大,差异有统计学意义(P 0.05)。2组术后12个月狭窄节段椎管矢状径、疼痛VAS评分、JOA评分差异无统计学意义(P0.05)。结论腰椎管狭窄症并硬脊膜损伤术中采用带蒂筋膜脂肪片修复椎管联合持续引流能使伤口及时愈合,减少并发症的发生,可以更好地预防术后出现硬膜外瘢痕粘连。     

玻璃酸钠与带蒂筋膜脂肪片预防椎管粘连的实验与临床研究

目的:探讨带蒂筋膜脂肪片与玻璃酸钠联合应用预防椎管粘连的可行性。方法:20只大白兔随机分为4组,切除每只动物L_1、L_3、L_5椎板造成3处椎板缺损。A组将玻璃酸钠注于硬脊膜周围后用带蒂筋膜脂肪片覆盖,B组用筋膜脂肪片覆盖,C组仅注玻璃酸钠,D组不用任何间置物覆盖。术后2、4、6、8、12周进行肉眼及光镜观察,并进行硬脊膜粘连程度分级。临床研究申将玻璃酸钠2～4ml注于病人硬脊膜周围后用带蒂筋膜脂肪片覆盖椎板缺损处。结果:术后12周时B、C、D组均形成了致密粘连,A组无粘连发生。157例病人术后随访6～64个月,优良率98.1％。结论:带蒂筋膜脂肪片与玻璃酸钠联合应用,能有效预防椎管内粘连。     

带蒂脂肪片加几丁糖预防腰椎间盘突出术后硬膜外瘢痕形成

目的探讨带蒂脂肪片加几丁糖预防腰椎间盘突出术后硬膜外瘢痕形成的临床效果。方法腰椎间盘突出症68例,随机分成两组:带蒂脂肪片加几丁糖组38例,对照组30例。其中带蒂脂肪片加几丁糖组以L3动脉为蒂的脂肪片覆盖于椎板开窗处,术后负压引流管拔出后,将4ml几丁糖从硬膜外导管注入椎板开窗处硬膜及神经根周围。结果按陆裕朴等疗效评定标准:带蒂脂肪片加几丁糖组优良率为92.10%、对照组为70.00%(P<0.05)。结论带蒂脂肪片加几丁糖能有效减少腰椎间盘突出术后硬膜及神经根周围的纤维化与粘连。     

带蒂和游离脂肪移植预防椎板切除后硬膜外瘢痕形成与粘连

本文以ＳＤ大鼠为实验对象，研究了游离与带蒂脂肪组织在预防椎板切除后硬膜外瘢痕形成与粘连的作用。通过肉眼、光镜、电镜、ＭＲＩ及计算机图像处理，结果显示：游离与带蒂脂肪组织均可有效地减小硬膜外的瘢痕形成与硬膜的粘连；二者坏死吸收等组织的变化和感染率相同；抑制椎板再生能力一致；炎细胞浸润带蒂组重于游离脂肪移植组；并首次提出了脂肪移植后“异位移植”的排异现象     

应用人工硬脊膜预防瘢痕粘连早期临床观察

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例病人末应用此人工材料，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。     

自体真皮移植预防硬膜外纤维化及粘连的实验研究

目的 探讨自体真皮移植预防硬膜外纤维化及粘连的效果,为临床应用提供实验依据.方法 选取5头西藏小型猪,手术切除L2、L4全椎板造成缺损,去除硬膜后方硬膜外脂肪暴露硬脊膜,切取自体真皮移植于L2椎板缺损处覆盖硬脊膜(实验组),L4椎板缺损处硬脊膜外不用任何移植物覆盖(自身空白对照组).于术后2、4、6、8、10周全麻下股动脉放血法各处死1头动物,大体观察移植真皮存活情况及是否存在毛发生长、皮脂腺和汗腺分泌物.采用改良Robertson记分法评定硬膜外瘢痕量及粘连程度,SPSS 13.0统计学软件进行统计分析.组织学观察移植真皮内皮肤附属器变化情况.结果 移植真皮全部成活,与体表真皮比较明显增厚(P<0.05).实验组未见移植真皮毛发生长、皮脂腺囊肿和汗液囊肿形成;真皮与硬脊膜之间存在潜在的易分离平面,只有极少量瘢痕组织,粘连疏松,硬膜表面和移植真皮表皮面光滑.对照组大量的瘢痕形成,竖脊肌前方瘢痕组织严重且广泛长人硬膜外腔,与硬脊膜粘连紧密,硬脊膜从瘢痕组织上分离困难.改良Robertson记分法评分,实验组硬膜外瘢痕量及粘连程度明显低于对照组(P<0.05).组织学观察见毛囊萎缩、毛根坏死、皮脂腺及汗腺消失.结论 自体真皮是一种具有良好的抑制瘢痕形成和物理隔离屏障作用的生物材料.自体真皮移植能有效地预防硬膜外纤维化及粘连,具有临床应用价值.     

带蒂脂肪浅筋膜瓣移植预防椎板切除后硬膜周围纤维化

带蒂脂肪浅筋膜瓣移植预防椎板切除后硬膜周围纤维化徐英杰张树伟王铁翔邢国利黄昌永椎板切除术后硬膜周围纤维化与瘢痕组织形成是造成术后疗效欠佳、残余症状乃至再发性下腰痛、坐骨神经痛，甚至手术失败的重要原因。作者采用带蒂脂肪浅筋膜瓣移植预防椎板切除术后硬膜周...     

脊柱膜与生物蛋白胶联合应用预防硬膜外粘连的实验研究

目的观察椎板切除术后联合使用脊柱膜与生物蛋白胶预防硬膜外粘连的效果,探讨从三维上预防粘连的最佳方案。方法本课题采用动物实验,运用拉丁方实验设计,分别做无植入（A组）,植入生物蛋白胶（B组）,脊柱膜（C组）,脊柱膜和生物蛋白胶（D）于兔的4个节段,术后4周对椎板切除部位进行大体观察、组织学观察及MR I检查,比较各组瘢痕形成和粘连情况。结果①A组可见大量瘢痕组织增生,以硬膜囊后方明显,粘连严重。②B组防粘连的效果差。③C组的防粘连的效果优于A组和B组,但差于D组。④D组,不但能够防止后方肌肉及疤痕组织的长入,而且可防止前方、周围硬膜及神经根的粘连。结论联合使用硬体材料脊柱膜和流体材料生物蛋白胶是防止椎板切除术后硬膜粘连的最佳方案。     

局部筋膜翻转预防椎板切除术后椎管粘连的研究报告

目的：探讨椎板切除后硬脊膜外瘢痕粘连的防治措施,为临床寻找一种实用有效的预防方法。方法：用１０只健康家犬,每只做４处椎板缺损,相隔两个椎体做一处。用翻转筋膜加带蒂脂肪、翻转筋膜加明胶海绵、自体游离脂肪和空白对照组随机植入椎板缺损处;以自体游离脂肪为标准对照,以未做特殊处理的椎板缺损区作为空白对照。双盲法观察２、３、４、８、１２周的瘢痕生长和硬膜外粘连情况。观察手段用大体观察,光镜观察,电子计算机图     

The effect of fat tissue autotransplantation on the changes in tissue surrounding the dura mater following laminectomy

Problems, probably caused by the adhesion of scar tissue to the dural sac or nerve roots, may appear after a laminectomy in which resection was required. In our department, free auto-fatty tissue transplantation has been clinically performed since 1979 in an effort to prevent this phenomenon, and favorable therapeutic results have been obtained. In the present study, the possible influence of extradural tissue on the dura mater over certain periods was investigated in post-laminectomized adult rabbits. Additionally, the inhibitory effect of transplanted fatty tissue on adhesion was examined. In the laminectomy-only subject group, a remarkable development of granulating tissue was observed. This tissue subsequently adhered to the dura mater, often resulting in a delayed repair of the dura mater and its surrounding tissue. In the fatty tissue transplanted group, on the other hand, the transplanted fat preserved its composition morphologically and rapid degeneration was deterred even in free grafts, so scar formation was inhibited at the site of the laminectomy. In comparison with the laminectomy-only group, furthermore, the repair of the tissue surrounding the dura mater was accelerated by the transplanted fatty tissue, beginning in the early postoperative stage.     

聚己内酯/聚乳酸膜防止硬膜外瘢痕粘连的实验研究

目的 探讨将聚己内酯／聚乳酸(polycaprolactone／polylactic acid,PCL/PIA)膜置于硬膜外,以减少硬膜外瘢痕粘连的方法。方法 用大鼠96只,L1、L3全椎板切除,分为空白对照组、自体游离脂肪片组及PCI／PIA膜组3组。术后1、3、6、12周处死动物。对硬膜外瘢痕形成及粘连做大体及组织学观察,逆转录,聚合酶链式反应(RT-PCR)方法检测硬膜外瘢痕中转化生长因子β(TGF-β)的表达,并用免疫组化法及RT-PCR法检测相应脊髓中P物质、c-fos的表达。结果 与空白对照组相比,PCL/PIA膜组硬膜外瘢痕粘连减轻,术后3周及6周时硬膜外瘢痕组织中TGF-β表达量明显减少,脊髓中P物质、c-fos表达减少;脂肪片早期可减轻硬膜外瘢痕粘连,但后期粘连也有所加重,脊髓中P物质、c-fos表达也有相应改变。结论 聚己内酯／聚乳酸膜可减轻硬膜外的瘢痕形成及粘连,使脊髓中疼痛介质P物质、c-fos表达减少,有助于防止术后腰腿痛的复发。     

Experimental study on pedicle fat grafts after laminectomy: comparison of pedicle fat and free fat grafts

Scar formation adherent to the dura and nerve roots causes recurrent symptoms following laminectomy. Free and pedicle fat grafts have been performed in low-back surgery as a preventive measure. An experimental study in rats was designed to compare pedicle fat grafts and free fat grafts after wide laminectomy, for efficacy in preventing scar formation and for effects on the spinal cord. The following results were obtained. 1) Dense scar formation over the dura and degeneration of the cord were seen at control laminectomy sites. 2) Free fat grafts, examined at 2 and 4 weeks postoperatively, showed death of portions of the graft, whereas pedicle fat grafts always demonstrated the presence of living fat. 3) At 4 months postoperatively, pedicle fat grafts were statistically superior to free fat grafts, which showed scarring over the dura and degeneration of the cord. In conclusion, pedicle fat grafts were more effective in preventing dural scar formation and protecting the cord than free fat grafts.     

Transcranial approach for venous embolization of dural arteriovenous fistulas

OBJECT: This study was undertaken to investigate the healing process and to delineate factors important for the survival of free fascial grafts used for dural repair. METHODS: A dural defect was created in guinea pigs and then reconstructed using either a free fascial graft or an expanded polytetrafluoroethylene (ePTFE) sheet. The fascial graft was covered directly by subcutaneous tissue (Group I) or by a silicone sheet to prevent tissue ingrowth from the subcutaneous tissue (Group II). The ePTFE sheet was covered with a silicone sheet (Group III). One or 2 weeks postoperatively, the strength of the dural repair was evaluated by determining the pressure at which cerebrospinal fluid (CSF) leaked through the wound margins. The dural repair was also histologically examined. In addition, using a rat model, specimens obtained from similar reconstruction sites were immunohistochemically stained with antibodies against basic fibroblast growth factor (bFGF), epidermal growth factor, or transforming growth factor-beta. The pressures at which CSF leaked after 1 and 2 weeks, respectively, were 50 +/- 14 mm Hg and 126 +/- 20 mm Hg in Group I, 70 +/- 16 mm Hg and 101 +/- 38 mm Hg in Group II, and 0 mm Hg and 8 +/- 8 mm Hg in Group III. Failure of repairs made in Group III occurred at significantly lower pressures when compared with Groups I and II. In Groups I and II, a thick fibrous tissue formed around the fascial graft. This tissue tightly adhered to adjacent dura mater. The fibrous tissue displayed a positive reaction for the presence of bFGF. In Group III, only a thin fibrous membrane surrounded the ePTFE sheet. CONCLUSIONS: Fascial grafts tolerated extraordinary intracranial pressures at 1 week postoperatively. Free fascial grafts can heal with durable fibrous tissue without the presence of a blood supply from an overlying vascularized flap.     

几丁糖防硬膜外粘连的实验与临床研究

目的 观察选择性脊神经后根切除术（ＳＰＲ）椎板切除术后硬膜几种防瘢痕粘连物质的作用及其机制。方法 用４８只ＳＤ大鼠制作硬膜外周围粘连模型,在损伤的硬膜表面涂布透明质酸钠,自体游离脂肪,几丁糖,生理盐水,分别于４,８,１２周观察瘢痕形成情况并测定胶原纤维含量。ＳＰＲ术后临床上用不同防粘连方法共２１６例,分４组即Ａ组硬膜外未作任何防粘连措施１５例,Ｂ组硬膜外涂布几丁糖作防粘连６４例Ｃ组为硬膜外涂布几丁     

几丁糖膜预防椎板切除术后硬膜周围粘连的实验研究

目的：观察几丁糖膜对预防椎板切除术后硬膜周围粘连的作用。方法：２４只成年新西兰白兔Ｌ３、Ｌ５水平切除椎板１０×０５ｃｍ,Ｌ３硬膜外放置几丁糖膜（Ａ点）,Ｌ５作为空白对照（Ｂ点）。分别于术后３周、６周、１２周进行大体形态、组织学观察。结果：Ａ点硬膜与瘢痕无明显粘连,硬膜外有空隙,未见明显异物、炎症反应;Ｂ点硬膜与瘢痕紧密粘连,瘢痕侵入椎管内,对硬膜有压迫。结论：几丁糖膜具有明显的预防硬膜周围粘连的作用。     

Novel biodegradable lamina for lamina repair and reconstruction

Background contextPosterior laminectomy is an effective spinal surgical procedure. The adhesion of postoperative scar tissue to surgically exposed dura and, occasionally, to nerve roots can cause failed back surgery syndrome. The establishment of a barrier between scar tissue and dura that is made of hard material may prevent scar adhesions.PurposeTo evaluate the efficacy of a novel biodegradable multi-amino acid copolymer/nanohydroxyapatite composite artificial lamina.MethodsA cervical laminectomy animal model in goats was used, and the animals were randomly divided into three groups. In the test group, cervical 4 was removed by laminectomy and the artificial lamina was inserted (n=12). In the control group, the incision was closed directly without implantation (n=9). The goats in the normal group did not undergo any procedure or treatment. Copolymer efficiency was tested by using X-ray, computed tomography scanning, magnetic resonance imaging, scanning electronic microscope, and histologic and biomechanical measurements 4, 12, and 24 weeks postoperation.ResultsNo shifting of the artificial lamina or dural adhesion pressure was observed. New cervical natural bone formed in the defect and the bony spinal canal was rebuilt. In the control group, fibrous scar tissue filled the defect and exerted pressure on the dura. No paralysis was observed, and gait was normal in all test and control goats.ConclusionsArtificial lamina can prevent the epidural adhesions surrounding the defect and promote effectively bone tissue repair and new bone formation.     

选择性脊神经后根切除术椎板切除后硬膜外防粘连的实验研究

目的观察选择性脊神经后根切除术（ＳＰＲ）椎板切除后硬膜外几种防瘢痕粘连物质的作用并探讨其机制。方法用４８只ＳＤ大鼠制作硬膜外周围粘连模型,在损伤的硬膜表面分别涂布透明质酸钠、自体游离脂肪、几丁糖、生理盐水,分别于４、８、１２周观察瘢痕形成情况并测定胶原纤维含量。结果生理盐水组大鼠硬膜外瘢痕自第４周开始形成,于第８周达高峰,１２周时开始软化、收缩;透明质酸钠与几丁糖预防瘢痕形成均有明显效果,其中几丁糖明显优于透明质酸钠;组织相容性以自体游离脂肪最好,其次是几丁糖、透明质酸钠。结论几丁糖对硬膜外周围瘢痕形成、粘连有明显预防作用     

壳多糖膜预防椎板切除术后硬膜周围粘连的实验研究

目的　观察壳多糖膜预防椎板切除术后硬膜周围粘连的作用。方法　２４ 只成年新西兰白兔 Ｌ３ 、 Ｌ５ 水平切除椎板１ ．０ ｃｍ ×０ ．５ ｃｍ , Ｌ３ 硬膜外放置壳多糖膜（ Ａ 点） , Ｌ５ 作为空白对照（ Ｂ 点） 。分别于术后３ 、６ 、１２ 周进行大体形态、光镜观察。结果　 Ａ 点硬膜外粘连程度明显低于 Ｂ 点;光镜观察 Ａ 点粘连范围明显低于 Ｂ 点, Ａ 点硬膜外有空隙,未见明显异物、炎症反应, Ｂ 点硬膜外与瘢痕紧密粘连,瘢痕侵入椎管内,对硬膜有压迫。结论　壳多糖膜具有明显的预防硬膜周围粘连的作用。