持续冲洗预防硬膜外术后粘连的实验研究

目的观察持续灌洗联合透明质酸钠局部应用对兔硬膜外粘连的预防效果。方法对25只成年健康新西兰白兔行椎板切除术,每只兔的背部均为3处切口,分别切除L1、L4、L7棘突、椎板,显露硬脊膜囊。将术后存活的22只白兔施行手术的66个节段随机分成3组：对照组（直接缝合）、几丁糖组（放置几丁糖膜）和冲洗组（持续灌洗72h后在拔管前注入透明质酸钠）。术后12周取材,进行大体和光镜检查并采用Rydell评分标准和改良Nussbaum评分标准比较组间差异。结果对照组硬膜外大量瘢痕组织填充,与周围组织难以分离;几丁糖组硬膜外瘢痕增生不明显,与硬膜之间有明显间隙,可与硬膜分离;冲洗组可见硬膜与肌肉组织之间为脂肪浸润和少量瘢痕出现,与硬膜部分粘连,易于分离。对3组的Rydell评分和改良Nussbaum评分结果进行两两比较,冲洗组和几丁糖组之间差异无统计学意义（P〉0.05）;分别将此两组与对照组进行比较,差异均有统计学意义（P〈0.05）。结论持续冲洗和局部应用透明质酸钠是预防硬膜外粘连的有效方法 。

An experimental study on preventive effect of continuous irrigation from peridural adhesion after laminectomy

Objective To observe the preventive effect of continuous irrigation with sodium hyaluronate injection from peridural adhesionaminectomy. Methods Laminectomies were performed in L1, L4, L7 of 25 New Zealand rabbits respectively with 3 incisions on their backs. Seventy-five segments of 22 rabbits who were still alive after laminectomy were divided randomly into 3 groups： control group （sutured directly）, chitosan （covered with chitosan） and irrigation group （irrigated continuously for 72 h and injected sodium hyaluronate through pipes）. The animals were sacrificed at 12 weeks. The specimens were prepared for macroscopy and light microscopy studies. The results evaluated by Rydell and Nussbaum criteria were compared among three groups. Results At 12 weeks, macroscopy and light microscopy showed that in contrl group, plenty of scars filled in as well as adhered to dura tightly; in chitosan group, the scars increased obviously but apparent interspace occurred and the scars could be separated to dura; in irrigation group, there were infiltrated fat and a small amounts of scars between dura and muscle, the scars were adherent to dura partly and also could be separated to dura easily.. According to Rydell and Nussbaum criteria, the difference between the results of chitosan and those of irrigation group had no statistical significance （P〉 0.05）, but e the difference among the results of two above groups and those of control group showed statistical significance （P〈 0.05）. Conclusion Continuous irrigation with sodium hyaluronate injection is an effective method for preventing peridural adhesion after laminectomy.