硬膜外阻滞后对椎间盘组织及黄韧带结构的影响

背景硬膜外阻滞(epiduralblock,EB)是治疗腰椎间盘突出症行之有效和广泛应用的方法之一,多次EB治疗后,对椎管内局部组织的结构有何影响,已有学者进行了动物实验研究.目的了解EB治疗腰椎间盘突出症是否对椎管内局部组织有影响.设计以患者为研究对象的非随机化同期对照观察.单位一所大学的附属医院及病理教研室、电镜室.对象1992-05/1997-12在中山大学附属第一医院骨科选择临床诊断腰椎间盘突出症患者经EB治疗无效,并行后路突出间盘切除的40例;以及同期非EB治疗而做手术切除的20例作对照研究.方法将60例手术中切取椎管腔面的黄韧带和间盘组织共120个标本做光镜检查,并从中选取EB组12例、非EB组10例的部分黄韧带和间盘组织制作44个电镜标本,分别送本校病理和电镜教研室专人制作及观察.主要观察间盘和黄韧带组织的外膜反应增生和炎症反应情况,次为纤维环、髓核、黄韧带组织内的超微结构变化情况.通过EB组40例、非EB组20例的黄韧带及间盘组织的组织学观察,以及前者12例、后者10例电镜超微结构观察的结果进行分析和比较.主要观察指标①主要结局椎间盘组织和黄韧带组织的椎管腔面外膜情况、炎症反应情况.②次要结局超微结构.结果光镜见黄韧带及间盘组织的腔面外膜光滑程度和炎症反应情况,EB组与非EB组比较无显著性差异;电镜下观察上述两种组织的纤维成份和排列以及细胞的超微结构,两组比较差异亦无显著性意义.结论两组患者实施腰椎EB后与椎管内瘢痕粘连形成无关,并对椎管内局部组织的超微结构没有明显影响,但因两组部分患者的黄韧带和间盘组织内有慢性炎症反应存在,故应做好无菌操作预防感染的发生.

Effect of epidural block on tissue structure of prolapsed intervertebral disc and yellow ligament

BACKGROUND: Epidural block(EB) is one of the effective and widely used remedies for lumbar disc herniation(LDH) . Animal experiments have been conducted to study the changes in the local tissue structure in the spinal canel after several treatments with EB.OBJECTIVE: To study the effect of EB for LDH on the local tissue structures in the spinal canel.DESIGN: A non-randomized and controlled clinical observation.PARTICIPANTS: Department of Pathology and Laboratory of Electron Microscope of an Affiliated Hospital of a University.SUBJECTS: Forty patients with LDP, who failed to respond to EB treatment and subsequently received discectomy in the Department of Orthopaedics,First Affiliated Hospital of Sun Yat-sen University from May 1992 to December 1997, were enrolled in this study, with 20 patients receiving discectomy but not EB treatment serving as the control group.METHODS: From the 60 cases, totally 120 specimens of yellow ligament and the disc tissues were obtained during discectomy for optical microscopical examination. A portion of the yellow ligament and the lumbar disc tissues were chosen from EB group(12 cases) and non-EB group(10 cases), respectively, for electron microscope examination(involving altogether 44specimens) . The changes in histology and ultrastructnres in the specimens were compared between the two groups.MAIN OUTCOME MEASURES: ① Main results: the reactive proliferation of the tunica adventitia and inflammatory reaction of the intervertebral disc and yellow ligament; ② Secondary results: changes in the ultrastructure of the anulus fibrosus, nucleus pulposus and yellow ligament.RESULTS: No significant difference was found between the two groups either in light microscopy or electron microscopy in the degree of smoothness and the inflammatory reaction of the cavosurface of the yellow ligament and the disc tissues, nor in the cellular ultrastructures and fibrous arrangement.CONCLUSION: There is no direct relationship between lumbar EB and epidural scar adhesion formation. EB does not affect the ultrastructures of the local tissues in the spinal canal, but care must be taken of the sterilization in the surgical procedure, as chronic inflammatory reaction in the yellow ligament and disc tissues can be present in some patients.