Micro-CT联合硬膜外造影在医用自交联透明质酸钠凝胶预防椎板切除后硬膜外粘连中的应用

背景：二维平面角度已证实医用自交联透明质酸钠凝胶能够在术后8周有效预防兔椎板切除后硬膜外粘连的发生。目的：应用Micro—CT联合硬膜外造影技术观察和评估自交联透明质酸钠凝胶预防椎板切除后硬膜外粘连的可行性。方法：将18只L5椎板全切除的新西兰大白兔随机分组：埘照组用生理盐水冲洗术区后关闭切口；HyaRegen／SPI组用医用自交联透明质酸钠凝胶HyaRegen／SP10．5mL覆盖暴露硬脊膜后关闭切口；HyaRegen／SPII纽用医用自交联透明质酸钠凝胶HyaRegen／SP110．5mL覆盖暴露硬脊膜后关闭切口。结果与结论：各组体感诱发电位潜伏期均无明显延长，3组间差异无显著性意义（P〉0．05）。Micro—CT联合硬膜外遗影扫描并三维重建后显示，HyaRegen／SPI组及HyaRegen／SPII组对比剂能够顺利充盈硬膜外间隙，列照组对比剂允盈不顺畅，在术区局部形成多处充盈缺损。HyaRegen／SPI组及HyaRegen／SPII组术区硬脊膜外单位体积内对比剂充盈体积均高于对照组（P〈0．05），前2组间差异无显著性意义（P〉0．05）。对照组硬膜外粘连程度要远高：rHyaRegen／SPI组及HyaRegen／SPII组（P〈0．05）。证实医用自交联透明质酸钠凝胶可有效预防兔椎板切除后硬膜外粘连的发生，应用Micro—CT联合硬膜外造影技术能有效观察和评估硬膜外粘连。

Application of Micro-CT combined with epidurography in medical self-crosslinked sodium hyaiuronate gel for the prevention of epidural adhesions after laminectomy

BACKGROUND： Medical self-crosslinked sodium hyaluronate gel can effectively prevent epidural adhesions after laminectomy in rabbits within 8 weeks after operation, which has been confirmed by planar angle. OBJECTIVE： To observe and evaluate the practicability of self-crosslinked sodium hyaluronate gel in preventing epidura adhesions by using Micro-CT combined with epidurography. METHODS： Eighteen new Zealand white rabbits with total lumbar laminectomy at L5 level were randomly divided into three groups： control, HyaRegen/SP 1 and HyaRegen/SP lI groups. In the control group, only normal saline was used to flush the laminectomy area before wound closure, while in HyaRegen/SPI and HyaRegen/SP II groups, the exposed dura mater was covered with 0.5 mL HyaRegen/SPI or 0.5 mL HyaRegen/SPII, respectively before wound closure. RESULTS AND CONCLUSION： The latency of cortical somatosensory evoked potentials was not delayed obviously in each group, and there was no significant difference in the three groups （P 〉 0.05）. The scanning of Micro-CT combined with epidurography and the images of three-dimensional reconstruction showed that contrast agent could fill the epidural space smoothly in the HyaRegen/SP 1 and HyaRegen/SP II groups, but not in the control group, and many filling defects in local operation area could been observed. In addition, the filling volume of contrast agent of the HyaRegen/SP I and HyaRegen/SP II groups in the unit volume of operation area was higher than that in the control group （P 〈 0.05） There was no significant difference between HyaRegen/SPI and HyaRegen/SP II groups （P 〉 0.05）. Moreover, the degree of epidural adhesions of the control group was significantly higher than that in the HyaRegen/SPI and HyaRegen/SP II groups （P 〈 0.05）. These findings suggest that medical self-crosslinked sodium hyaluronate gel can effectively prevent epidural adhesions after laminectomy in rabbits. Besides, epidural adhesions can be observed and evaluated effectively by using Micro-CT combined with epidurography.