不同处理方法在牵张性脊髓损伤中的的疗效比较-外科学专业论文.docxVIP

- - 1 - 不同处理方法对牵张性脊髓损伤的疗效比较 中 文 摘 要 目的 探讨不同处理方法在牵张性脊髓损伤中的疗效差异及其机制。 方法 以牵张 L1/L2 小关节突 50%距离制备大白兔脊髓损伤模型，模型建立后，32 只大白兔随机分为 4 组，空白对照组（A 组）不予任何处理，椎板减压组（B 组）、解除牵张组（C 组）、椎板减压+解除牵张组（D 组）分别予以椎板 减压、解除牵张、解除牵张并椎板减压处理。造模第 1、3、7、14d 分别采 用 BBB 评分法对各组大白兔脊髓损伤程度进行评分。第 14d 处死大白兔后， 取损伤区中心脊髓组织，进行 HE 染色及免疫组织化学染色检测凋亡相关蛋 白 Bcl-2、Bax 的表达。结果 脊髓损伤模型成功建立。造模第 7、14d 大 白兔脊髓损伤程度空白对照组较椎板减压组轻，较解除牵张组和椎板减压+ 解除牵张组重，且有显著性差异。空白对照组脊髓组织中 Bcl-2 的表达较 椎板减压组显著升高，但显著低于解除牵张组和椎板减压+解除牵张组；空 白对照组中 Bax 的表达较椎板减压组显著减低，但显著高于解除牵张组和 椎板减压+解除牵张组；解除牵张组和椎板减压+解除牵张组之间 Bcl-2、Bax 的表达无差异。结论 椎板减压组较空白对照组脊髓损伤程度加重,可能是 在未解除牵张情况下进行椎板减压在一定程度上加重了脊髓缺血,致损伤 加重；解除牵张组与椎板减压+解除牵张组之间无显著差异,可能的原因为 解除牵张后损伤修复与缺血再灌注及椎板减压致缺血共同作用，其作用机 制有待于进一步研究；解除牵张组与椎板减压+解除牵张组较空白对照组、 椎板减压组脊髓损伤程度明显减轻，，可能与上调 Bcl-2、下调 Bax 的表达， 抑制细胞凋亡有关。脊髓损伤的严重程度与 Bcl-2 的表达负相关、Bax 的表 达正相关。解除牵张是处理牵张性 SCI 最有效、最根本的处理方法 关键词：牵张性脊髓损伤；细胞凋亡；Bcl-2；Bax - - PAGE 2 - The effect of different treatment methods in the stretch spinal cord injury ABSTRACT Objective: To investigate the effect of different treatment methods in the stretch spinal cord injury and analysis of its mechanisms. Methods : The white rabbits spinal cord injury (SCI) model were established by stretching the 50% distance of L1/L2 facet joint. After creating the model, 32 rabbits randomly divided into four groups: blank control group(group A) had no treatment, decompressive laminectomy group(group B)、relieve tension group(group C)、 decompressive laminectomy and relieve tension group(group D) were separately given to lamina decompressionrelieve tension 、relieve tension and lamina decompression treatment. The 1、3、7、14 days conducted with BBB scoring method to observed the degrees of SCI. The 14th day, the rabbits were sacrificed and spinal cord tissue were collected from the center of damage areas, observed by HE staining. Bcl-2 and Bax were detected with immunohistochemical staining. Results: SCI of rabbits have been established. The 7th、14th day the degrees of SCI in the blank control group were significantly lighte