聚乳酸凝胶预防肌腱粘连的实验研究

目的:聚乳酸凝胶(PLA-G)置于肌腱吻合部,观察防粘连作用.方法:将16只兔左后肢比目鱼肌腱切断一半后吻合,鞘内涂PLA-G为实验组;兔的右后肢同样操作,不涂PLA-G为对照组.术后2、4、6、10周随 机取动物每组2只共4只的手术段肌腱和鞘管做大体、组织及超微观察.结果:(1)大体:实验组2周时PLA-G隔离好无粘连;4周开始降解,肌腱滑动良好;6、10周瘢痕小,吻合口生长及滑动良好.对照组瘢痕大、广泛粘连;(2)组织:实验组纤维排列由不规则向规则变化,成纤维细胞少.对照组腱与鞘无分界,成纤维细胞增生、胶原分泌活跃;(3)超微:实验组成纤维细胞粗面内质网较对照组明显稀疏、胶原纤维少.结论:PLA-G具防粘连作用,不影响肌腱愈合.     

保存硬脊膜预防椎管内术后粘连的实验研究

28只大白兔随机分为实验和对照2组,均切除L5椎板,造成12mm×5mm的硬膜囊裸露区后,实验组用酒精保存的同种异体硬脊膜覆盖,对照组不用任何间置物覆盖、术后2、4、8、12周时进行肉眼及光镜观察,8周时还进行硬膜外粘连等级评定及病理切片的计算机图像分析。结果显示,对照组硬膜外腔消失,逐渐形成致密粘连,实验组硬膜外间隙存在,粘连明显少于对照组,揭示保存硬脊膜可以有效的预防椎管内术后粘连。     

聚乙交酯膜预防椎管术后硬膜外瘢痕粘连的实验研究-大体组织学改变

目的观察聚乙交酯(PGA)膜对预防椎板切除术后硬膜周围粘连的作用.方法在新西兰兔L3、L5部位切除椎板1.0cm×0.5cm,一缺损处在硬膜外放置PGA膜,另一缺损部放置明胶海绵或空白对照,于术后3、6、9、12周作形态和组织学观察.结果大体形态观察PGA膜3周时开始降解,6周时分解成较大碎片,9周时吸收60%～80%,12周时仅残留部分小碎片,硬膜外无瘢痕粘连.明胶海绵和空白对照组瘢痕粘连发生率为88%和100%.组织学检查PGA膜组各时点均未见硬膜外纤维组织产生,硬膜与背侧组织无粘连,明胶海绵组(除3周外)和空白对照组均产生明显的粘连.结论PGA膜能有效防止椎管术后瘢痕粘连.     

同种异体骨板覆盖预防硬膜外瘢痕粘连的实验研究

目的 探讨经冻干辐照处理后的同种异体骨板预防椎板切除术后硬膜外瘢痕粘连的作用。方法 12只成年雄性绵羊,随机分成A、B两组,每组6只。两组均作L3,4和L4,5椎板切除,A组的L4,5和B组的L3,4椎板缺损用“H”形同种冻干辐照骨板覆盖,为实验节段;A组的L3,4和B组的L4,5不覆盖骨板作为对照节段。于术后4、8、12、16、20和24周取材,行大体、X线平片和组织切片观察;并对4、24周取材行CT扫描。结果 术后4周,实验节段可见同种骨板形态、位置保持完好,椎管内无狭窄,硬膜囊无压迫,镜下椎板咬除缘有多量新生骨小梁生成,周边有大量软骨细胞及其分泌黏多糖和坏死后所留下的空腔,骨板内侧有增生纤维组织及少量炎性细胞浸润;对照节段可见大范围致密的纤维组织夹杂变性坏死肌肉嵌入椎板缺损处,硬膜广泛粘连,硬膜囊受压。术后24周,实验节段椎管重建基本完成,覆盖骨板吸收完全,并与再生椎板融合,椎管形态完好,硬膜外未见瘢痕组织;对照节段椎板再生未完成,瘢痕组织自椎管外嵌入椎管内,压迫硬膜囊及脊髓,硬膜外间隙几乎消失。统计学分析表明手术后期（16～24周）,实验节段与对照节段相比硬膜粘连程度明显减轻,椎管矢状径均较对照节段大,硬膜囊形状保持良好,无明显压迫。结论 同种异体冻干辐照骨板在实验羊椎板切除后的硬膜外能有效减少瘢痕形成和粘连。     

聚乳酸薄板预防椎板切除术后硬脊膜外纤维瘢痕粘连的实验研究

以60只家兔全椎板（L3，L5）切除为实验模型，研究了自制的聚乳酸薄板、明胶海绵在预防硬膜外纤维瘢痕粘连中的作用。通过大体观察及组织学检查，结果显示，聚乳酸薄板生物相容性好，能降解，可吸收，局部存留时间长，能有效地防止椎板切除后硬膜外纤维瘢痕粘连；明胶海绵早期防止纤维瘢痕粘连有一定作用，晚期作用不明显。     

壳多糖膜预防椎板切除术后硬膜周围粘连的实验研究

目的　观察壳多糖膜预防椎板切除术后硬膜周围粘连的作用。方法　２４ 只成年新西兰白兔 Ｌ３ 、 Ｌ５ 水平切除椎板１ ．０ ｃｍ ×０ ．５ ｃｍ , Ｌ３ 硬膜外放置壳多糖膜（ Ａ 点） , Ｌ５ 作为空白对照（ Ｂ 点） 。分别于术后３ 、６ 、１２ 周进行大体形态、光镜观察。结果　 Ａ 点硬膜外粘连程度明显低于 Ｂ 点;光镜观察 Ａ 点粘连范围明显低于 Ｂ 点, Ａ 点硬膜外有空隙,未见明显异物、炎症反应, Ｂ 点硬膜外与瘢痕紧密粘连,瘢痕侵入椎管内,对硬膜有压迫。结论　壳多糖膜具有明显的预防硬膜周围粘连的作用。     

钛合金微粒对硬膜外瘢痕粘连形成影响的实验研究

目的观察钛合金微粒对硬膜外瘢痕粘连的影响方法36只成年新西兰兔随机分为3组.切除L5椎板后造成10mm×5mm硬膜裸露区,A组植入钛合金微粒,B组植入不锈钢微粒,C组作为空白对照,术后4、8、12周分别进行肉眼和光镜观察,8周时进行硬膜外粘连等级评分和计算机图像分析.结果4周时3组均有大量瘢痕形成,瘢痕尚未成熟,其间可见纤维母细胞.8周时瘢痕成熟,肉眼及光镜硬膜外粘连等级评分,三组间无显著差异(P>0.05),计算机图像分析示A组、C组的粘连程度均轻于B组(P<0.01),而A组与C组无显著差异(P>0.05).12周时瘢痕组织转化为骨组织,硬膜外大量新生椎板形成,呈松质骨状.结论钛合金微粒对于硬脊膜及硬膜外组织具有良好的生物相容性,其对硬膜外瘢痕粘连的形成及发展无影响.     

预防硬膜外瘢痕粘连的实验研究

目的通过动物实验观察几丁糖对预防椎板切除术后硬膜瘢痕粘连的作用。方法24只成年山羊行腰2腰4短节段椎弓根钉系统固定及取自体髂骨行后外侧植骨融合术,腰3水平全椎板切除,切除口约3cm×1.5cm,腰3硬膜外分别放置几丁糖或空白对照各12只。于术后24周进行大体形态、组织学观察,并进行硬膜外瘢痕粘连程度分级。结果几丁糖组硬膜与瘢痕无明显粘连,空白对照组硬膜与瘢痕紧密粘连。结论几丁糖能有效地预防椎板切除术后硬膜外瘢痕粘连。     

预防椎板切除术后硬膜周围纤维化与粘连的实验研究

以９６只ＳＤ大鼠全椎板切除为实验模型，研究了高分子纤维，透明质酸钠，游离脂肪在预防硬膜周围纤维化与粘连中的作用。通过肉眼，光镜，电观察，电子计算机图像分析，增强ＭＲＩ扫描，结果显示；椎板切除后硬膜周围纤维化的高峰在术后８周内。ＨＵＣＭＣ生物相容性好、能降解、可吸收、药物局部存留时间长、覆盖均匀、作用完善可起到三维的遮挡保护作用能有效地防止椎板切除后膜周围的纤维化与粘连。     

带蒂和游离脂肪移植预防椎板切除后硬膜外瘢痕形成与粘连

本文以ＳＤ大鼠为实验对象，研究了游离与带蒂脂肪组织在预防椎板切除后硬膜外瘢痕形成与粘连的作用。通过肉眼、光镜、电镜、ＭＲＩ及计算机图像处理，结果显示：游离与带蒂脂肪组织均可有效地减小硬膜外的瘢痕形成与硬膜的粘连；二者坏死吸收等组织的变化和感染率相同；抑制椎板再生能力一致；炎细胞浸润带蒂组重于游离脂肪移植组；并首次提出了脂肪移植后“异位移植”的排异现象     

Effect of polylactic acid glue in preventing epidural scar mdhesion after laminectomy in rabbits

Objective： To determine the efficacy of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits. Methods： Twenty-four Japanese white rabbits underwent laminectomy （including the attached ligaments） at Lz and Ls. After laminectomy at Ls, polylactic acid glue was sprayed on the dura and nerve roots and this segment was taken as the experimental group. After laminectomy at Lz, nothing was used and this segment was enrolled as the self control group. Four rabbits were killed every two weeks postoperatively till the end of the experiment at 12 weeks. Then the operated spine was observed grossly, histologically and ultrastructurally to check the degree of scar formation, the status of epidural scar adhesion, the absorption of the glue, and the intraceHular structure of fibroblasts. Results： The glue coagulated immediately after spraying and showed excellent hemostatic effect. The glue membrane was easy to be taken away from the dura mater of the samples for 2 weeks and there were no cells in the epidural space in the experimental group. But the dura mater was covered by hematoma in the control group,which formed mild adhesion, with fibroblasts proliferating actively. In the 4th week, some glue shivers remained in the epidural space with fibroblasts increasing a little, and the dura mater was smooth in the experimental group. However, in the control group, the formed scar was fragile and conglutinated with the dura mater diffusely and fibroblasts were much more than those in the experimental group. In the 6th-12th weeks, there was a potential interspace between the scar and the dura mater, and the polylactic acid glue was absorbed completely in the experimental group. Much tough scar was found in the control group, which was very difficult to dissect from the dura mater and the surrounding tissues. From the ultrastructural observation of the fibroblasts, the nucleus became much bigger and the rough endoplasmic reticulum was much more plentiful in the control group than that in the experimental group. Conclusions： Polylactic acid glue can effectively reduce epidural cicatrization and adhesion.     

Effect of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits

Objective: To determine the efficacy of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits. Methods: Twenty-four Japanese white rabbits underwent laminectomy (including the attached ligaments) at L2 and L5. After laminectomy at L5, polylactic acid glue was sprayed on the dura and nerve roots and this segment was taken as the experimental group. After laminectomy at L2, nothing was used and this segment was enrolled as the self control group. Four rabbits were killed every two weeks postoperatively till the end of the experiment at 12 weeks. Then the operated spine was observed grossly, histologically and ultrastructurally to check the degree of scar formation, the status of epidural scar adhesion, the absorption of the glue, and the intracellular structure of fibroblasts. Results: The glue coagulated immediately after spraying and showed excellent hemostatic effect. The glue membrane was easy to be taken away from the dura mater of the samples for 2 weeks and there were no cells in the epidural space in the experimental group. But the dura mater was covered by hematoma in the control group, which formed mild adhesion, with fibroblasts proliferating actively. In the 4th week, some glue shivers remained in the epidural space with fibroblasts increasing a little, and the dura mater was smooth in the experimental group. However, in the control group, the formed scar was fragile and conglutinated with the dura mater diffusely and fibroblasts were much more than those in the experimental group. In the 6th-12th weeks, there was a potential interspace between the scar and the dura mater, and the polylactic acid glue was absorbed completely in the experimental group. Much tough scar was found in the control group, which was very difficult to dissect from the dura mater and the surrounding tissues. From the ultrastructural observation of the fibroblasts, the nucleus became much bigger and the rough endoplasmic reticulum was much more plentiful in the control group than that in the experimental group. Conclusions: Polylactic acid glue can effectively reduce epidural cicatrization and adhesion.     

Mitomycin C-polyethylene glycol controlled-release film inhibits collagen secretion and induces apoptosis of fibroblasts in the early wound of a postlaminectomy rat model

Background contextRecovery from spine surgery is usually accompanied with the development of epidural scar adhesions from the abnormal proliferation of fibroblast and extracellular matrix–related metabolism. Polyethylene glycol (PEG) could alleviate the postsurgical adhesion formation with still leaving a gap between the sheet and the dura. However, PEG film could not function as a three-dimensional barrier to prevent adhesion completely. Mitomycin C (MMC) could also reduce the scar formation after surgery, but cytotoxicity and the administrative pathway prevent its application.PurposeOur purpose was to design and attest the role of new delivery system MMC-PEG controlled-release film in preventing the epidural scar adhesions after laminectomy in the rat model.Study design/settingA total laminectomy of L1 in the rat model was used to assess epidural fibrosis between and around the spinal nerves using a histochemistry assessment along with flow cytometry analysis.Patient sampleThe sample comprises 64 adult male Sprague-Dawley rats.Outcome measuresThe outcome measures are macroscopic evaluation, histological analysis, and flow cytometry analysis.MethodsLumbar laminectomies at L1 and L2 with a L1–L2 disc injury were performed on 64 adult male Sprague-Dawley rats. The rats were then randomized into four groups. In Group I, 25 mg PEG film was applied on the dura mater in the laminectomy area before the layers were sutured. In Group II, a cotton pad soaked with 0.05% MMC solution was kept on the laminectomy area for 5 minutes. In Group III, 25 mg PEG film containing 0.01% MMC was implanted on the laminectomy area. In Group IV, the laminectomy area was flushed with saline before wound closure. The rats were sacrificed 4 weeks after the operation. Macroscopic evaluation and histological analysis of epidural scar adhesion with the hematoxylin and eosin stain and Masson stain were used followed by the quantification of hydroxyproline (Hyp) and flow cytometry analysis of the apoptosis of fibroblasts in the scar tissues.ResultsThe recovery of all rats was uneventful after the operations. In the laminectomy sites of rats treated with MMC or MMC-PEG, the dura mater was clean without any evident adhesion or membrane. Collagen tissue hyperplasia significantly decreased in the MMC- or MMC-PEG–treated models. Accordingly, Hyp concentration was significantly reduced in these two groups compared with saline-control group. In addition, the apoptosis of fibroblasts, however, was significantly elevated in the MMC or MMC-PEG group compared with the saline-control group.ConclusionsThese results demonstrate that the treatment of postlaminectomy wounds with MMC-PEG film reduces the severity of adhesion by decreasing the concentration of Hyp and increasing the apoptosis of fibroblasts.     

Effect of fibrin glue on postlaminectomy scar formation

Summary An experimental study in rats has been carried out with the aim of studying the scar formation over the spinal dura in the presence of fibrin glue. Although the main action of fibrin glue is the enhancement of wound healing by increasing the fibrous tissue, our present data suggest that this re-absorbable biomaterial diminishes the epidural scar formation, at least the first two weeks after laminectomy. This finding leads us to consider the use of fibrin glue over spinal duramater when it is likely that reoperation may become necessary in a short period of time after a laminectomy.     

聚己内酯/聚乳酸膜防止硬膜外瘢痕粘连的实验研究

目的 探讨将聚己内酯／聚乳酸(polycaprolactone／polylactic acid,PCL/PIA)膜置于硬膜外,以减少硬膜外瘢痕粘连的方法。方法 用大鼠96只,L1、L3全椎板切除,分为空白对照组、自体游离脂肪片组及PCI／PIA膜组3组。术后1、3、6、12周处死动物。对硬膜外瘢痕形成及粘连做大体及组织学观察,逆转录,聚合酶链式反应(RT-PCR)方法检测硬膜外瘢痕中转化生长因子β(TGF-β)的表达,并用免疫组化法及RT-PCR法检测相应脊髓中P物质、c-fos的表达。结果 与空白对照组相比,PCL/PIA膜组硬膜外瘢痕粘连减轻,术后3周及6周时硬膜外瘢痕组织中TGF-β表达量明显减少,脊髓中P物质、c-fos表达减少;脂肪片早期可减轻硬膜外瘢痕粘连,但后期粘连也有所加重,脊髓中P物质、c-fos表达也有相应改变。结论 聚己内酯／聚乳酸膜可减轻硬膜外的瘢痕形成及粘连,使脊髓中疼痛介质P物质、c-fos表达减少,有助于防止术后腰腿痛的复发。     

几丁糖膜预防椎板切除术后硬膜周围粘连的实验研究

目的：观察几丁糖膜对预防椎板切除术后硬膜周围粘连的作用。方法：２４只成年新西兰白兔Ｌ３、Ｌ５水平切除椎板１０×０５ｃｍ,Ｌ３硬膜外放置几丁糖膜（Ａ点）,Ｌ５作为空白对照（Ｂ点）。分别于术后３周、６周、１２周进行大体形态、组织学观察。结果：Ａ点硬膜与瘢痕无明显粘连,硬膜外有空隙,未见明显异物、炎症反应;Ｂ点硬膜与瘢痕紧密粘连,瘢痕侵入椎管内,对硬膜有压迫。结论：几丁糖膜具有明显的预防硬膜周围粘连的作用。     

活血止痛汤对硬膜外瘢痕组织中羟脯氨酸含量及其超微结构的影响

目的:评价活血止痛汤预防实验性椎板切除术后硬膜外瘢痕形成与粘连的疗效。方法:雄性SD大鼠90只随机分成空白对照组、透明质酸钠组、活血止痛汤组,每组30只。手术切除L4-L5腰椎椎板,造成0.25cm×1cm硬脊膜裸露区,透明质酸钠组于硬膜囊外均匀地涂抹一层透明质酸钠约0.3ml,其余2组以等量生理盐水处理。术后2周内活血止痛汤组予活血止痛汤2.5ml/kg灌胃;空白对照组和透明质酸钠组予等量生理盐水。术后第2、4、8周末处死动物,测定其硬膜外瘢痕组织中羟脯氨酸含量,按Rydell法评定粘连程度,透射电镜观察其超微结构。结果:第2周时,透明质酸钠组羟脯氨酸含量明显低于空白对照组(P<0.05),而活血止痛汤组虽然也较低,但差异无统计学意义(P>0.05);第4周时,与空白对照组相比,透明质酸钠组和活血止痛汤组羟脯氨酸含量均较低(P<0.05),但透明质酸钠组和活血止痛汤组的差异缺乏显著性。第8周时,活血止痛汤组羟脯氨酸含量不仅低于空白对照组(P<0.01),而且其与透明质酸钠组亦有显著性差异(P<0.05)。大体观察也发现透明质酸钠组和活血止痛汤组粘连程度明显降低(P<0.05)。各时相透明质酸钠组和活血止痛汤组瘢痕中成纤维细胞以及细胞内的细胞器数量均减少,胶原纤维的合成受到抑制。结论:活血止痛汤能降低硬膜外瘢痕中羟脯氨酸的含量,抑制瘢痕组织中成纤维细胞和胶原的代谢,减少硬膜外瘢痕的形成和粘连。