人工生物膜修复椎间盘纤维环的研究

目的 用不同方法处理椎间盘纤维环,观察人工生物膜对椎间盘纤维环缺损的修复作用.方法 成年山羊8只,雌雄各4只,对每只羊的腰椎(腰2/3、腰3/4、腰4/5)椎间盘纤维环进行随机处理,处理方法包括:(1)暴露出椎间盘纤维环,不作任何处理;(2)暴露出椎间盘纤维环后,将其切开,用人下生物膜填充缺口;(3)暴露出椎间盘纤维环,尖刀将其切开,作为对照组.12周后,通过生物力学测试、核磁共振(MRI)及脱钙病理切片染色观察椎间盘纤维环的修复效果.结果 12周后,测试纤维环承受最大压力,单纯暴露组为(4.92±0.17)MPa,纤维环单纯切开组为(2.48±0.39)MPa,人工生物膜修复组为(3.76±1.56)MPa.人工生物膜修复组与单纯切开组,椎间盘纤维环完整性及生物强度均不如单纯暴露组,人工生物膜修复组优于单纯切开组,两组间的差异有统计学意义(P＜0.05),人工生物膜可与椎间盘纤维环的胶原纤维良好融合.结论 人工生物膜可对椎间盘纤维环缺口起到修复作用,能使其生物力学强度平均恢复76.4%,人工生物膜可以促进椎间盘结构完整性的恢复.

The dura gide to annulus fibrosus closurement

Objective To evaluate the repair efficiency of dura gide to intervertebral disc annulus fibrosus defect. Methods Totallly 24 lumbar intervertebral discs of 8 sheep underwent one of the following 3 methods: (1) the disc annulus fibrosus was exposed through retroperitoneal approach without any farther procedure; (2) the disc annulus fibrosus was exposed and a defect was made, and then the defect was repaired with dura gide; (3) the disc annulus fibrosus was exposed and a defect was made as control. At the 12th week after surgery, 15 discs of 5 sheep underwent pressure-volume testing to assess the competency of the annulus fibrosus. MRI images and decalcified histology were performed on the remaining 9 discs of 3sheep. Results At the 12th week, the mean max-pressure in expose-only, excise-only and dura gide-reparied group was (4. 92 ±0. 17), (2. 48 ±0.39) and (3.76 ± 1.56) MPa, respectively. Both the competency in excised-only and dura gide-repaired groups was lower than in exposed-only group. The competency in dura gide-repaired groups was higher than in excise-only group ( P ＜ 0. 05 ). MRI images and histology indicated that dura gide-repaired specimens were integrated well with the disc annulus fibrosus collagen.Conclusion There was a repair efficiency of dura gide to intervertebral disc annulus fibrosus defect. The mean competency recovery rate was 76.4%.