几丁糖与人工骨联合应用预防椎板切除术后硬膜外粘连的实验研究

目的:观察椎板切除术后用几丁糖(CHT)的同时在椎板缺损处植入磷酸三钙人工骨(TCP)预防硬膜外瘢痕粘连的效果。方法:40只纯种日本大耳白兔随机分成A、B、C、D四组,制作L4椎板损伤模型。A组硬膜外涂布生理盐水,B组硬膜外涂布几丁糖,C组硬膜外覆盖人工骨,D组硬膜外涂布几丁糖的同时加人工骨覆盖。术后12周对椎板切除部位进行大体观察、组织学观察及生化检查,比较各组间瘢痕形成和粘连情况。结果:B、C、D组的改良Rydell-Balazs粘连韧度评分、胶原含量及改良Nussvaum组织学评分均优于A组(P<0.01),D组优于B组与C组(P<0.05),B组与C组无显著性差异(P>0.05)。结论:联合应用几丁糖和人工骨能有效预防硬膜外瘢痕粘连的形成,比单独应用几丁糖和人工骨预防效果好。

Prevention of epidural adhesion after laminectomy by the use of chitin combined with artificial bone

Objective:To observe the effect of chitin cooperated with artificial bone(beta-tricalcium phosphate,TCP) in the prevention of fibrous scar formation in the epidural space after laminectomy.Method:40 rabbits were divided randomly into 4 groups.Laminectomy was performed in lumbar 4 segment,and the exposed duras were covered with saline solution(group A),chitin(group B),TCP(group C),and chitin combined with TCP(group D) respectively.Gross score,biochimical and histological evaluation of the vertebral laminae involved were carried out at 12 weeks postoperatively.Result:The Rydel-Balazs score,amount of collagen and Nussvam score in group B?C?D were obviously higher than those in group A(P<0.01),the effect of group D was superior to that of group B and C,no significant difference between group B and C was observed(P>0.05).Conclusion:Use chitin cooperated with TCP has a better effect on prevention of peridural adhesion after laminectomy than use of chitin or TCP alone.