一种生物型人工硬脑膜和自体膜应用的对比研究

目的通过对临床病人及犬的开颅手术,比较应用新型生物型人工硬脑膜与自体骨膜修补硬脑膜的预后。方法选择临床手术病人30例,24例行生物型人工硬脑膜修补硬脑膜,6例行自体膜修补;选择的实验犬分为:1、6、12、24个月及更长时间5组,每组犬各3只,每只犬分别应用生物型人工硬脑膜及自体膜修补硬脑膜。手术后观察不同修补材料的预后。结果所有临床病人术后观察均无颅内感染、脑脊液漏及癫发生。应用生物型人工硬脑膜修补材料的动物解剖显示,修补材料外表面与颅骨膜有少许粘连、易分离,与周边缝合的硬脑膜已完全愈合,不可分辨,不能分离。从生物型人工硬脑膜及自体膜两种修补材料内表面来看,前者生长更接近硬脑膜,与脑表面无粘连或偶有丝状粘连,而自体膜与脑表面有丝状粘连并有少许柱状粘连。组织学镜下显示,两种修补材料与硬脑膜之间无嗜中性粒细胞、淋巴细胞等炎症细胞反应,无囊壁形成。生物型人工硬脑膜内表面可见上皮细胞覆盖,上皮下可见纤维组织增生,纤维母细胞增生,该修补材料被降解,总量明显减少,内部可见毛细血管。结论用生物型人工硬脑膜作硬脑膜修补手术后,该型修补材料的特性使其能产生上皮,不易形成与脑组织的粘连,并逐渐被自体组织蚕食、降解和替代,达到具有实际意义的硬脑膜重建。生物型人工硬脑膜在修补硬脑膜缺损的实际应用中比自体膜有更大优越性。

The experimental applied study of the contrast between a biological artificial duramater and the autogenous membrane

Objective By means of performing the skull surgical operations on clinical patients and dogs to replace the orthotopic duramater with a new biological artificial duramater and an autogenous membrane,the prognosis of the reparation of the injured dura with the new biological artificial duramater and the autogenous membrane was observed.Methods Thirty clinical patients were chosen for the experiment,among whom 24 were performed the skull surgical operations of replacing the orthotopic duramater with a new biological artificial duramater,and 6 accepted the operations of replacing the orthotopic duramater with an autogenous membrane.All animals for the experiment were divided into 5 groups with 3 in each group.The observed periods were 1,6,12,24 months or longer respectively.The dural mater of each animal was replaced by implanting a new biological artificial duramater and an autogenous membrane to replace its orthotopic duramater.After the operation,the prognosis of the different implantations in the animals in each group was observed.Results The observation showed that after the operation there were no encephalic infection,no leakage of cerebrospinal and no epilepsy in all the clinical patients.The anatomy of the animals to which the new biological artificial duramater and autogenous membrane were applied to replace their orthotopic duramaters showed a little bit easily detachable adhesion of the outside surface of the two replacement materials to the skull periosteum.The animal's orthotopic dura mater sutured around got cured completely,without visible interface between the implanted dura and the orthotopic duramater.The inner surface of the two replacement materials showed that the growth of the new biological artificial duramater is much closer to the orthotopic duramater,with no adhesion or occasional filamentous adhesion to the brain surface;while there was filamentous adhesion and a little pillar adhesion between the autogenous membrane and the brain surface.Histological and microscopic observations showed that there were no inflammatory cellular factors such as neutrophil cells,lymphoid cells and so on,and there was no cyst wall at the interface.The inner surface of the new artificial duramater was seen to be covered with epithelial cells.The proliferations of the fibrous tissues and fibroblast were seen under the epithelia.The implanted material was degraded with a distinct reduction in its total amount.Capillaries were seen inside the material.Conclusion The observation after the operation of the injured duramater reparation showed that the nature of the new artificial duramater allowed epithelial cells to grow as well as avoided the adhesion to the brain tissues and would gradually be encroached,degraded and replaced by the recipient's autologous tissues so that the duramater could be reconstructed in a practical way.The study reveals that the new artificial duramater has a much more practical advantage over the autogenous membrane in the reparation of the injured duramater.