摘要
背景:瘢痕组织的生成以及随之形成的与硬脊膜及神经根的粘连一直是影响椎板切除后疗效的重要因素之一。如何减少或预防这种粘连或瘢痕形成,是临床医生着重研究的问题。目的:探索术中保留黄韧带对预防腰椎椎板切除后硬脊膜周围粘连的作用。方法:将40只新西兰大白兔随机分为黄韧带切除组与黄韧带保留组,每组实验动物20只,均行L4-5椎板切除术,模拟髓核摘除,术中分别保留或切除黄韧带。参考Rydell-balazs评分标准和Nuss-baum组织学评分标准,评定椎板切除后硬脊膜与周围结组粘连情况。结果与结论:①所有手术均顺利完成,黄韧带保留组椎板切除区仍可见瘢痕组织,硬脊膜与周围组织粘连轻,容易钝性分离。黄韧带切除组可见手术创面肌肉明显瘢痕化,并有类骨质形成,其与脊柱背侧肌肉及软组织粘连紧密,钝性分离非常困难;②黄韧带保留组Rydell-balazs与Nuss-baum评分显著低于和黄韧带切除组(P <0.05);③结果提示,保留黄韧带可降低硬膜外瘢痕形成,减少硬脊膜与周围组织粘连。
BACKGROUND:Formation of scar tissue and the consequent formation of adhesions with dura and nerve root is an important factor for postoperative outcomes of laminectomy.How to reduce or prevent the adhesion or scar formation has been paid much attention in the clinic.OBJECTIVE:To explore the effect of preserving the ligamentum flavum on preventing dural adhesions after laminectomy in lumbar surgery.METHODS:Forty New Zealand white rabbits were randomly divided into ligamentum flavum resection group and ligamentum flavum preservation group(n=20 per group).All animals underwent L4-5 laminectomy,simulating nucleus pulpotomy.Postoperative dural adhesion was assessed according to Rydell-balazs and Nuss-baum criteria.RESULTS AND CONCLUSION:The operations were successfully completed,and there was visible scar in the operation area in the ligamentum flavum preservation group,the dura adhesion was easy to be separated bluntly from surrounding tissue.In the ligamentum flavum resection group,the scar tissue around the dura was very dense and the dural adhesions were serious,even osteoid was observed.The Rydell-balazs and Nuss-baum scores in the ligamentum flavum preservation group were significantly lower than those in the ligamentum flavum resection group(P<0.05).To conclude,retaining the ligamentum flavum can reduce epidural scarring and adhesion of the dura to the surrounding tissue.
作者
李树文
杨哲
银和平
吴一民
白明
杜志才
王宇鹏
孟格栋
Li Shuwen;Yang Zhe;Yin Heping;Wu Yimin;Bai Ming;Du Zhicai;Wang Yupeng;Meng Gedong(the Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,Inner Mongolia Autonomous Region, China)
出处
《中国组织工程研究》
CAS
北大核心
2019年第3期416-420,共5页
Chinese Journal of Tissue Engineering Research
基金
内蒙古自治区自然科学基金(2017MS08126)
项目负责人:李树文~~
