椎管内原发性肿瘤手术椎板棘突复位和切除的随机对照研究

目的评价在椎管内原发性肿瘤手术中采用椎板棘突复位和传统椎板切除的临床疗效。方法将72例椎管内原发肿瘤随机分为治疗组和对照组。治疗组行椎板棘突复位术;对照组行椎板棘突咬除术。比较两组脊髓神经功能恢复程度、脊髓截面积、脊柱不稳和成角畸形发生率。结果术后3、6、12个月脊髓损伤ASIA分级及脊髓横截面积两组比较有显著差异(P<0.01)。术后3、6、12个月治疗组未发现明显脊柱成角畸形和脊柱不稳病例;而对照组脊柱成角畸形率分别为14.71%、29.42%、58.84%,脊柱不稳率分别为23.53%、52.94%、88.24%,两组相比有显著差异(P<0.01)。结论椎板棘突复位术恢复了椎管正常生理解剖和次序,保证了脊柱的稳定,脊髓神经功能恢复完全,有效地防止了术后并发症的发生。     

干扰素/聚乳酸-羟基乙酸共聚物及壳聚糖/聚乳酸-羟基乙酸共聚物复合膜防止椎板切除后的硬膜外瘢痕粘连

摘要 背景：应用硬膜外阻隔材料是预防椎板切除后硬膜外瘢痕粘连的一种方法,而制备既有机械阻隔能力,又有抑制成纤维细胞的能力的复合膜是其中一个重要的研究方向。 目的：制备壳聚糖/聚乳酸-羟基乙酸共聚物[poly(lactic-co-glycolic acid), PLGA]与干扰素/PLGA复合膜,观察其防止兔椎板切除后硬膜外瘢痕粘连的作用。 方法：大耳白兔120只行L2椎板切除,随机分为6组：对照组硬膜外不放任何物质;自体游离脂肪移植组取皮下脂肪贴于硬膜表面;透明质酸钠组将透明质酸钠1 mL 滴于硬膜外;PLGA膜组、壳聚糖/PLGA及干扰素/PLGA复合膜组,分别将各种膜修剪成合适大小植于硬膜外。术后2,4,6,8 周处死动物,观察L2术区的瘢痕形成及与硬膜粘连的情况并评分。术后4周,透射电镜下观察成纤维细胞的超微结构。 结果与结论：随着时间的延长,对照组形成较广泛的瘢痕。游离脂肪组和PLGA膜组的瘢痕量少于对照组。透明质酸组早期瘢痕形成量明显少于自体游离脂肪组和PLGA膜组,后期无显著性差异,但优于对照组。壳聚糖/PLGA膜组与干扰素/PLGA膜组硬膜外瘢痕的形成量最少,与硬膜无或轻微粘连,其作用明显优于其他各组,但两种复合膜组间差异不明显。术后4周,对照组、游离脂肪组和PLGA膜组的成纤维细胞的状态和功能明显好于壳聚糖/PLGA膜组与干扰素/ PLGA膜组。壳聚糖/PLGA复合膜与干扰素/ PLGA复合膜是预防椎板切除后硬膜外瘢痕粘连的有效材料。 关键词：聚乳酸-羟基乙酸共聚物;干扰素;壳聚糖;硬膜外瘢痕;椎板切除 doi:10.3969/j.issn.1673-8225.2010.47.043     

经关节突滑膜和椎板肌肉附着点感受器通路给药治疗椎间盘突出性腰腿痛：1 236例分析*****

背景：髓核中炎症递质诱导神经根炎症是产生腰腿痛主要因素。感受器通路系列研究发现，神经系统存在自身循环，经感受器通路给药有靶向给药的功效。 目的：分析经腰椎关节突滑膜和椎板肌肉附着点给药治疗椎间盘突出性腰腿痛1 236例治疗效果。 设计、时间及地点：病例分析，于2002-03/2007-03在连云港市第一人民医院完成。 对象：选择疼痛科就诊的椎间盘突出性腰腿痛患者1 236例。男370例，女866例。年龄20~80岁。患者腰腿痛伴有腰椎间盘膨出、突出物小于椎管的1/3。 方法：患者经腰椎间盘膨出、突出的椎关节突和椎板注射药物，药物配方：复方倍他米松（得宝松）5 mg+左氧氟沙星0.1 g + 20 g/L利多卡因5 mL+生理盐水氯化钠至20 mL+透明质酸钠（施沛特）20 mg。1次/周，2，3次为1个疗程。1个月以内不要过度负重。 主要观察指标：治疗效果和复发率。 结果：1 236例椎间盘突出性腰腿痛患者1个疗程临床治愈1 142例（94%），好转89例（7.2%）,无效5例(0.4%)。1年随访资料完善的322例，未复发250例（77.6%），复发72例（22.4%）；2年随访资料完善的206例，未复发155例（75.2%），复发51例（24.8%）；3年随访资料完善的91例，未复发74例（81.3%），复发17例（18.7%）；4年随访资料完善的62例，未复发52例（83.8%），复发10例（16.2%）；5年随访资料完善的32例，未复发27例（84.3%），复发5例（15.6%）。 结论： 经腰椎关节突滑膜和椎板肌肉附着点感受器通路给药治疗椎间盘突出性腰腿痛简单有效。     

Spinal deformities after laminectomy in children

The authors discuss the problem of spinal deformity developing after laminectomy in the light of treated case. Clinical observations and literature survey indicate the necessity of orthopaedic consultation before operations impairing stabilization of the spine. Laminectomy, particularly with disturbance of the stability of articular processes is an indication to spondylodesis, and the presence of kyphosis and absence of posterior spinal elements are the primary indication to anterior spondylodesis.     

自体脂肪颗粒与尿激酶联合应用预防硬膜外粘连*

背景：椎板切除后,易发生硬膜外粘连。术后在硬膜外单独应用1种药品或隔离物,效果不甚理想。 目的：观察自体脂肪颗粒与尿激酶联合应用预防椎板切除后硬膜外粘连的效果。 方法：64只成年新西兰兔随机分为模型组、尿激酶组、自体脂肪颗粒组、尿激酶+自体脂肪颗粒组,各16只。手术切除L5椎板造成12 mm×5 mm 硬脊膜裸露区,探查神经根。模型组注入生理盐水,尿激酶组注入尿激酶(25 U/kg), 自体脂肪颗粒组用自体游离脂肪颗粒覆盖,尿激酶+自体脂肪颗粒组用尿激酶(25 U/kg)注入后再用自体游离脂肪颗粒覆盖。术后2,4周行大体观察及组织学观察,6 周时行硬膜外瘢痕面积定量分析。 结果与结论：模型组椎板切除部位明显粘连,尿激酶组、自体脂肪颗粒组轻度粘连,尿激酶+自体脂肪颗粒组无明显粘连。尿激酶组、自体脂肪颗粒组、尿激酶+自体脂肪颗粒组成纤维细胞数显著低于模型组(P < 0. 05),尿激酶+自体脂肪颗粒组成纤维细胞数低于尿激酶组、自体脂肪颗粒组(P < 0.05)。自体脂肪颗粒组、尿激酶+自体脂肪颗粒组瘢痕面积显著低于模型组、尿激酶组(P < 0.05),尿激酶+自体脂肪颗粒组瘢痕面积低于自体脂肪颗粒组。提示脂肪颗粒及尿激酶联合应用对预防椎板切除后硬膜外粘连具有协同作用,效果显著。     

Serum concentrations of phenytoin after oral administration in rats

Phenytoin (115 mg/kg) was given orally to rats in order to determine serum concentration levels of the drug. It was found that the peak concentration in serum was 8 micrograms/ml 1 h postadministration , with little variation being noted for up to 8 h. The relevance of these findings in terms of behavioral studies is discussed.     

Failure of nimodipine to prevent ischemic neuronal damage in rats

The efficacy of nimodipine in preventing ischemic brain injury was tested in rats subjected to a 20-minute period of high-grade forebrain ischemia by 4-vessel occlusion. Three minutes after restoration of circulation to the brain, an intravenous bolus of 5 micrograms/kg nimodipine or an equivalent amount of vehicle or saline was given, followed by continuous intravenous infusion of the respective solution at 1 microgram/kg/min for 2 hours. In a second series, a larger bolus (20 micrograms/kg of nimodipine) and longer infusion period (6 hours) were employed. Histopathology of the brain was evaluated blindly 72 hours later and graded on a conventional 3-point scale. There was no significant effect of treatment in either series. In the 6-hour series, the percent of cerebral hemispheres showing damage of Grades 2 or 3 in zone CA1 of the hippocampus and in the striatum, respectively, was 100 and 40% for the nimodipine-treated rats, 100 and 42% for rats receiving vehicle, and 75 and 25% for animals receiving saline. Thus, this study revealed no beneficial effect of nimodipine when given following a 20-minute period of severe forebrain ischemia.     

Topical use of colchicine to prevent spinal epidural fibrosis in rats

Abstract

Objectives: Epidural fibrosis after spinal surgery may be the cause in most cases of recurrent pain. Numerous pharmacological agents and anti-adhesive barriers have been used to prevent epidural fibrosis, but the success rates are variable. Colchicine is an historical drug extracted from the flowers of Colchium autumnale widely used in arthritic conditions in the past. Currently, it is used in acute gout attacks, familial mediterranean fever for its anti-inflammatory and antifibrotic effects. Also, colchicine is used locally in the cutaneous diseases (e.g. actinic keratoses, psoriasis) for its similar effets. In present study, we investigated the effect of topical colchicine on spinal epidural fibrosis in the rats.

Methods: The rats were randomly divided to three groups of six animals each. Total L4-5 laminectomy was performed, and ligamentum flavum and epidural fat were removed gently. Meticulous hemostasis was achieved by using cotton pad when necessary, and no bone wax and cauterization were used. Dura was left clean with no hemorhages. In treatment group cotton pads (5 × 5 mm) soaked with 0.005 mg/ml colchicine and applied on laminectomy sites for 10 minutes and remowed, in sham group only saline irrigation was done. In control group no medication or irrigation was applied. The wound was closed in layers using the same material in each group. Four weeks later, the rats were killed, and the spinal column, including surrounding muscle tissue, was removed en bloc, decalcified, and fixed in formaldehyde. Epidural fibrosis was evaluated histologically.

Results: In colchicine-treated group, epidural fibrosis was significantly reduced compared with control and sham groups.

Conclusions: Epidural fibrosis is a well-known complication following lumbar disc surgery. Topical application of colchicine is very effective in preventing epidural fibrosis.     

Oxypurinol administration fails to prevent hypoxic-ischemic brain injury in neonatal rats

The purpose of the present study was to determine whether oxypurinol, a xanthine oxidase inhibitor, reduces free radicals and brain injury in the rat pup hypoxic-ischemia (HI) model. Seven-day-old rat pups had right carotid arteries ligated followed by 2.5h of hypoxia (8% oxygen). Oxypurinol or vehicle was administered by i.p. injection at 5 min after reoxygenation and once daily for 3 days. Brain damage was evaluated by weight deficit of the right hemisphere at 22 days following hypoxia. Oxypurinol treatments did not reduce weight loss in the right hemisphere. Brain weight loss in the right hemisphere were -26.2+/-3.6, -15.2+/-6.9, -21.7+/-4.4, -15.8+/-5.1, and -16.7+/-3.4% in vehicle (n=33), 10 (n=17), 20 (n=16), 40 (n=15), and 135 mg/kg (n=13) oxypurinol-treated groups (p>0.05), respectively. Brain thiobarbituric acid-reacting substances (TBARS) were assessed 3 and 6h after reoxygenation. Concentrations of TBARS rose 1.5-fold due to HI. Oxypurinol did not significantly reduce an HI-induced increase in brain TBARS. Thus, xanthine oxidase may not be the primary source of oxy-radicals in pup brain and as such oxypurinol does not prevent free radical-mediated lipid peroxidation or protect against brain injury in the neonatal rat HI model.     

Potential risk of mitomycin Cat high concentrations on peripheral nerve structure

Although the local application of mitomycin C may prevent epidural adhesion after laminectomy, mitomycin C can induce neurotoxicity in optic and acoustic nerves at high concentrations. To determine the safe concentration range for mitomycin C, cotton pads soaked with mitomycin C at different concentrations(0.1, 0.3, 0.5, and 0.7 mg/mL) were immediately applied for 5 minutes to the operation area of rats that had undergone laminectomy at L1. Rat sciatic nerves, instead of dorsal nerves, were used in this study. The results showed that mitomycin C at 0.1–0.5 mg/mL did not damage the structure and function of the sciatic nerve, while at 0.7 mg/mL, mitomycin C significantly reduced the thickness of the sciatic nerve myelin sheath compared with lower concentrations, though no functional change was found. These experimental findings indicate that the local application of mitomycin C at low concentrations is safe to prevent scar adhesion following laminectomy, but that mitomycin C at high concentrations( 0.7 mg/mL) has potential safety risks to peripheral nerve structures.     

细胞黏附分子(ICAM-1)在大鼠弥漫性脑损伤中的表达意义

目的探讨ICAM—1在大鼠弥漫性脑损伤中的表达及意义。方法采用Marmarou方法获得大鼠弥漫性脑损伤模型．实时定量RT—PCR、S—P免疫组化法分别测定ICAM—1蛋白和mRNA在外伤后不同时间点的表达变化．干湿重法测脑组织含水量．组织切片苏木精一伊红染色观测炎性细胞浸润情况。结果外伤组与假手术对照组比较，ICAM—1蛋白表达分别于伤后6h明显升高．72h达到高峰（P〈0.05），ICAM—ImRNA表达3h即明显升高，72h达最高峰，其后下降。7d时仍高于假手术对照组（P〈0．01）。伤后脑组织含水量较假手术对照组高，同时炎性细胞大量聚集。结论大鼠脑外伤诱导了ICAM—1的表达．ICAM—1通过介导炎性细胞的浸润可能参与了伤后脑水肿的形成过程．     

医用几丁糖凝胶预防输卵管复通后的粘连

背景：近年来随着微创技术的普及,输卵管介入复通治疗输卵管阻塞已较普遍,但患者术后粘连仍是困扰临床医生的一大难题。目的：总结近年来医用几丁糖凝胶预防输卵管再通术后粘连的应用现状。方法：由第一作者检索1998-02/2011-02万方数据库,以“医用几丁糖凝胶;腹腔镜;治疗;输卵管妊娠”等为检索词,检索几丁糖在输卵管介入再通术中预防术后粘连方面的文献。排除重复研究或较陈旧文献。共保留相关文献30篇进行分析。结果与结论：医用几丁糖是一种具有良好生物相容性、生物可降解性、生物学活性的医用高分子多糖类物质。其具有广谱抑菌作用,选择性促进上皮细胞、内皮细胞生长而抑制成纤维细胞生长的生物学特性,从而促进组织生理性修复,促进切口迅速修复,抑制瘢痕形成,减少组织粘连,具有润滑、生物屏障作用,能有效的阻止粘连发生,促进输卵管功能的恢复,为再次妊娠打下基础。