腰椎板切除术后硬膜外粘连预防方法的研究进展

腰椎板切除术后硬膜外瘢痕粘连是下腰椎手术失败综合征(failed back surgery syndrome,FBSS)的病因之一,可引起腰腿疼痛或神经损伤症状。预防和减少腰椎板切除术后硬膜外瘢痕形成,对提高腰椎手术疗效具有重要意义。椎板切除后骶棘肌粗糙面和椎间盘损伤纤维环是硬膜外纤维化和瘢痕形成的主要来源,目前硬膜外粘连的主要预防方法包括植入物阻隔、药物抑制和低剂量放射线照射等,但大多还处于动物实验阶段,其临床应用仍不确定。临床研究如自体游离脂肪移植、ADCON-L和丝裂霉素C(MMC)的结果仍有争议,未得到医学界共识和和广泛应用。理想植入物材料应具有良好的生物相容性、无不良反应、可降解吸收、在体内维持一定时间,药物的选择应抗粘连作用好、不良作用小、半衰期长。此外,药物联合生物可降解医用膜,两种或多种医用膜联合也是预防硬膜外粘连及瘢痕形成的研究方向,需要进一步研究探索新的组织材料及药物,以稳定有效地预防硬膜外瘢痕粘连。

Update on prevention of epidural adhesion after lumbar laminectomy

Postoperative epidural adhesion is one of the most common causes of failed back surgery syndrome (FBSS),which can lead to back and leg pain or neurological deficit. Prevention of epidural adhesion after laminectomy is critical for improving the outcomes of lumbar surgery. The main origins of epidural fibrosis are raw surface of erector muscles and rupture fibers of intervertebral disc. The main current preventive methods for epidural adhesion include the usage of implants,chemicals and low dose radiation. However,most of them are still in experiment period. There are still controversies on the clinic usage of autograft free fat,ADCON-L,and Mitomycin C (MMC). The optimal implants are characteristics of better biocompatibility,degradable absorption and capability of existing for a certain period in body. The optimal medicine should have good effect on anti-desmoplasia,less side effects and long half-life. Besides,the combination of biodegradable medical film and drug and the mixture of two or more medical films are also the research frontlines of epidural adhesion. Further researches are required to explore new materials and drugs with stable and most favorable effect in preventing epidural adhesion.