聚乙烯醇凝胶膜预防椎板切除术后硬膜外粘连的实验研究

目的:采用聚乙烯醇凝胶膜预防椎板切除术后粘连,并用自体脂肪、明胶药膜对照,以期寻找一种更理想的预防"椎板切除膜"的方法.方法:用42只SD大鼠,随机分为聚乙烯醇凝胶膜组、明胶药膜组、自体脂肪组和空白对照组,切除L1椎板后,分别覆盖上述材料,术后4、6、8周取材,进行肉眼和组织学观察.结果:空白对照组4、6、8周均现硬脊膜与硬膜外纤维瘢痕广泛粘连.明胶药膜组4周开始出现硬膜外粘连,6、8周出现广泛的纤维瘢痕粘连.自体脂肪组术后4周有大量炎性细胞浸润,但硬膜外无粘连,6周炎性细胞减少,硬膜外无粘连,8周有血管再生,硬膜外无粘连.聚乙烯醇凝胶膜组术后4、6、8周均无硬膜外粘连.结论:聚乙烯醇凝胶膜预防椎板切除术后硬膜外粘连和炎症反应的作用非常显著(P＜0.05)组织相容性好.自体脂肪组织在移植成活的前提下有阻止椎板切除术后硬膜外粘连的作用.明胶药膜术后4周即被完全吸收,无预防椎板切除术后硬膜外粘连的作用.

Experiment of Polyvingl Alcohol Hydrogel Membrane that Effectively Prevents Epidural Fibrosis at Laminectomy

Study Design.The effectiveness of Polyvingl Alcohol Hydrogel(PVAH) sheet,as a barrier material for the prevention of postlaminectomy scar formation was evaluated in 42 rats(SD).14 animals each were killed at 4,6,8 weeks postoperation.Objective:This study determined the ability of PVAH sheet to prevent perineural scar and compared the results to those obtained using free fat graft and gentamycin gelatin membrane and nonimplanted control subjects.Methods:Wide laminectomy was performed at L1 in 42 rats.The dura was covered with a PVAH sheet,free fat graft,gentamycin gelatin membrane or without interposition as a control.Animals were killed at 4,6,8 weeks.Results:In the gentamycin gelatin membrane group and the control group,adhesion of the exposed dura was apparent.Thick fibrous connective tissue was observed between the dura and the paravertebral muscles.In the free fat graft group,at four week,the inflammatory cells migrated in the fat tissue.At eight week,no or only mild inflammatomy cells were observed.Micrangium regenetation was observed in some fat tissues.The dura was seperatived from the scar tissue by living grafted fat.In the PVAH sheet group,the postoperative inflammatomy reactions and adhesion of the exposed dura were prevented.The sheet was subsequently encapsulated by a thin synovium-like connective tissue membrane.Conclusions:The PVAH sheet appears more useful for preventing postoperative inflammatory reactions and adhesion of the exposed dura..It's low friction allows the adjacent spinal cord and the nerve roots to move in spinal canal.If the antibiotics-contained PVAH sheet used in experiment and clinic successfully,it would be very useful material to prevent the laminectomy membrane in the future.