透明质酸钠复合纤维蛋白凝胶预防硬膜外粘连实验探究.docVIP

透明质酸钠复合纤维蛋白凝胶预防硬膜外粘连实验探究[摘要]目的 观察透明质酸钠（HA）复合纤维蛋白凝胶(FG)预防椎板切除术后硬膜外粘连的效果。方法 新西兰兔24只，行L4、L5、L6椎板切除，72个节段分3组，分别植入HA、FG和HAFG复合凝胶。术后4、8、12周处死动物，取出腰椎，分别行大体、组织、生化及MRI研究。结果 HAFG复合凝胶在局部存留时间较长，能有效地防止硬膜外粘连。单独使用HA或FG早期有一定预防粘连作用，晚期作用不明显。结论 HAFG复合凝胶能减少实验动物椎板切除术后硬膜外瘢痕形成，中长期防粘连效果较单独使用两种凝胶更为可靠。? [关键词] 椎板切除；硬膜；粘连；透明质酸钠；纤维蛋白凝胶 ? [中图分类号] R687.3;R318.08 [文献标识码] A [文章编号] 1671-7562(2007)02-０１０１-０４?? Prevention from peridural fibrosis and adhesion after laminectomy ?by combined application of fibrin glue and sodium hyaluronate?? WANG Chen,QIAN Wei-qing,CHEN Chang-hong (Department of Orthopaedics,Zhongda Hospital,Southeast University,Nanjing 210009,China)?? Abstract:Objective To study the effect of various materials including sodium hyaluronate(HA),fibrin glue(FG)and the combination of HA or FG(HAFG)on prevention of peridural fibrosis and adhesion(PDFA)after laminectomy.Methods Twenty-four rabbits were randomly divided into HA,FG and HAFG three groups,and each group had 8 rabbits.A 3-level lumbar laminectomy was performed on each rabbit.Materials above were applied to the laminectomy sites.PDFA were assessed by gross observation,histological examination,biochemistry examination and MRI investigation.Resultsthe composition of HA and FG could persist more time than either HA or FG in local laminectomy sites.As a three dimensional protective material,HAFG could effectively inhibit PDFA after laminectomy,but HA or FG only had some effect in the early stage,not in the later period.ConclusionHAFG is believed to be useful in reducing epidural scar adhesion after laminectomy,and it′s long term effect to prevent postsurgical epidural scar adhesions is satisfactory.? Key words:laminectomy;dura;adhesion;sodium hyaluronate;fibrin glue? (Modern Medical Journal,2007,35:101-104)?? 椎板切除术后硬膜周围纤维化及瘢痕形成可引起硬膜和神经根周围的粘连，使硬膜囊受压，这是下腰椎手术失败综合征的主要原因之一。因此，预防术后硬膜外粘连具有重要的临床意义。我们联合应用两种性质不同的凝胶预防椎管内粘连，取得了较好的效果。? 1 材料与方法? 1.1 实验动物及分组? 新西兰兔24只，体重2.5~3.2kg，雌雄不限。对每只兔施以L4、L5和L6全椎板切除，共72个