摘要
目的：通过大体观察、组织学观察及羟脯氨酸浓度分析，评估两种医用自交联透明质酸钠凝胶——HyaRegen／sPI和HyaRegen／SPII预防椎板切除术后硬膜外粘连的效果。方法：将L5全椎板切除的新西兰兔36只随机分为3组（n=12）。A组为对照组，术区生理盐水冲洗后关闭切口；B组和C组为实验组，分别在暴露出的硬膜外覆盖HyaRegen／SP10．5m1和HyaRegen／SPII0．5ml后关闭切口。所有动物术后8周予以安乐死，完整切下脊柱节段（L4～6）进行如下评估。①对硬膜外粘连程度进行大体观察，并根据Rydell标准进行分级；②对标本进行组织学观察和评估；③取术区硬膜外背侧少量瘢痕组织行羟脯氨酸浓度分析。结果：大体观察发现，A组硬膜外粘连严重、无法完整分离，而B组及c组未见明显粘连，A组的粘连程度Rydell分级要远高于B组和C组（P〈0．05）；组织学观察发现3组均在原椎扳切除术区形成大量新生骨，不同的是A组新生骨下可见广泛而致密的硬膜外粘连，脊髓向背侧牵拉，硬膜外间隙消失，而B组和C组新生骨下可见极少量瘢痕组织，硬脊膜表面光滑，未与周围组织形成粘连，硬膜外间隙存在，进行组织学评级后发现B组和C组之间差异无统计学意义（P〉0．05），分别与A组比较，差异均有统计学意义（P〈0．05）；羟脯氨酸浓度分析结果显示B组、C组瘢痕组织中羟脯氨酸浓度要明显低于A组（P〈0．05）。结论：两种医用自交联透明质酸钠凝胶（HyaRegen／SPI和HyaRegen／SPII）均能够在术后8周有效预防新西兰兔椎板切除术后硬膜外粘连的发生。
Objective：To evaluate the effectiveness of two kinds of medical self - crosslinked sodium hyaluronate gel （HyaRegen/SPI , HyaRegen/SPII） in preventing epidural adhesions after laminectomy by general observation, histological evaluation and analysis of hydroxyproline concentration. Methods： Thirty - six New Zealand white rabbits with lumbar laminectomy at L5 were randomly assigned into three groups： group A was served as control with only saline being used to flush the laminectomy area before wound closure, while group B and C were served as treated group with the exposed dura mater being covered with 0.5 ml HyaRegen/ SPI or 0.5 ml HyaRegen/SPII respectively before wound closure. All animals were euthanized at post - surgery 8 weeks, and the spinal section （L4_6） was removed and evaluated as follows： 1. the epidural adhesion degree by macroscopic observation according to the Rydell standard, 2. the histological observation and evaluation of the specimen, 3. the hydroxyproline concentration analysis of scar tissue in the backside of the dura mater. Results：The macroscopic evaluation revealed serious epidural adhesions in group A that was hard to dissect and excise while almost no adhesion in group B and C, and the adhesion degree in both groups was significantly lower than that in group A （P 〈 0.05 ）. The histological observations revealed that there was new bone formation in the operative area in each group of animals： in group A under the new bone extensive and tenacious epidural scar adhesion was formed and the spinal cord was pulled to dorsal side that caused the disappearance of epidural space, while in group B and C there was little epidural scar adhesion under the new bone, the dura mater was clean without any evident adhesion to the surrounding tissue and epidural space could be seen clearly. The histological grades of epidural adhesion showed that there were no significant differences between group B and C （P 〉 0.05 ）, but there were both significantly lower than that in gro
出处
《解剖与临床》
2012年第2期115-119,共5页
Anatomy and Clinics
