防止椎板切除术后硬脊膜外瘢痕粘连的实验研究

作者在４个平面间隔切除１１只山羊的椎板，分别用硅胶膜、自体游离脂肪片、带蒂肌肉瓣覆盖硬脊膜，一处平面作空白对照。术后４个月组织学检查，结果显示，硅胶膜后方有少许瘢痕组织增生，间质中有炎细胞灶状浸润，硅胶膜与硬膜囊无瘢痕形成，新形成的椎管后壁光滑，硬膜囊无受压；脂肪片被纤维组织取代，周围纤维组织增生轻微，形成菲薄之纤维膜，与硬脊膜容易分离；带蒂肌肉瓣周围形成较多瘢痕与硬脊膜粘连重，肌肉瓣已完全纤维化，空白组形成瘢痕最多，与硬脊膜粘连最重。术后硬膜囊矢状径以硅胶膜组最大，脂肪片组次之，带蒂肌肉瓣组再次之，空白组最小。作者认为，硅胶膜与脂肪片能明显防止椎板切除术后纤维瘢痕粘连对硬膜囊的压迫，在支架诱导作用方面，硅胶膜优于脂肪片，在生物相容性方面脂肪片优于硅胶膜。带蒂肌肉瓣优于对照组，但不及前两者。

Prevention of Nerve Compression by Fibrous Scar Tissue in the Epidural Space Following Laminectomy:an Experimental Study

Eleven goats were used as the animal model in this study. Laminectomy was performed in four intervertebral spaces,and the exposed dura were covered with silicone membrane, free fat and pedicled muscular flap respectively. In the control group, only laminectomy was done, Four months following the operation, computed tomography myelography (CTM) was used for the measurement of the sagittal and transverse diameters of the dural sac and histological examination was carried out. The results revealed that,only a small amount of fibrous tissue without scar were seen between the silicone membrane and the dural sac; the free fat was replaced by fibrous tissue and a thin fibrous membrane was formed on the surface of the dura; the muscular flap was totally changed by fibrous tissue resulting in large amount of scar tissue adherent to the dura .In the control group,the most plenty amount of scar tissue was found and there was severe adhesion with the dura. Measurement of the dura sac on the CTM revealed that the group with the dura covered with silicone membrane having the largest sagittal diameters and then in the descending order, the groups with the dura covered with the free fat,the muscular glap and the controls.The findings of this study indicated the prevention effect of the silicone membrane and the free fat on the formation of fibrous tissue causing compression and adhesion of the exposed dura following laminectomy.