自体脂肪颗粒与尿激酶联合应用预防硬膜外粘连

背景：椎板切除后,易发生硬膜外粘连。术后在硬膜外单独应用1种药品或隔离物,效果不甚理想。目的：观察自体脂肪颗粒与尿激酶联合应用预防椎板切除后硬膜外粘连的效果。方法：64只成年新西兰兔随机分为模型组、尿激酶组、自体脂肪颗粒组、尿激酶＋自体脂肪颗粒组,各16只。手术切除L5椎板造成12mm×5mm硬脊膜裸露区,探查神经根。模型组注入生理盐水,尿激酶组注入尿激酶（25U/kg）,自体脂肪颗粒组用自体游离脂肪颗粒覆盖,尿激酶＋自体脂肪颗粒组用尿激酶（25U/kg）注入后再用自体游离脂肪颗粒覆盖。术后2,4周行大体观察及组织学观察,6周时行硬膜外瘢痕面积定量分析。结果与结论：模型组椎板切除部位明显粘连,尿激酶组、自体脂肪颗粒组轻度粘连,尿激酶＋自体脂肪颗粒组无明显粘连。尿激酶组、自体脂肪颗粒组、尿激酶＋自体脂肪颗粒组成纤维细胞数显著低于模型组（P〈0.05）,尿激酶＋自体脂肪颗粒组成纤维细胞数低于尿激酶组、自体脂肪颗粒组（P〈0.05）。自体脂肪颗粒组、尿激酶＋自体脂肪颗粒组瘢痕面积显著低于模型组、尿激酶组（P〈0.05）,尿激酶＋自体脂肪颗粒组瘢痕面积低于自体脂肪颗粒组。提示脂肪颗粒及尿激酶联合应用对预防椎板切除后硬膜外粘连具有协同作用,效果显著。

Prevention of peridural adhesion using autologous fat particles combined with urokinase

BACKGROUND：Peridural adhesion easily occurred after laminectomy.There is not an ideal drug or spacer to prevent adhesion.OBJECTIVE：To study the effectiveness of combination of auto-genous fat particle and urokinase on prevention of peridural adhesion.METHODS：Totally 64 adult New Zealand rabbits were randomly divided into the model,urokinase,autogenous fat particle and autogenous fat particle＋ urokinase groups,with 16 animals in each group.Laminectomy was performed on the 5th lumbar segment and the duramater （12 mm×5 mm） was exposed.The exposed duramater was covered with saline,urokinase （25U/kg）,autogenous fat particle or the combination of autogenous fat particle and urokinase （25U/kg） in the model,urokinase,autogenous fat particle and autogenous fat particle＋ urokinase groups,respectively.The specimens were observed grossly and histologically at 2 and 4 weeks postoperatively.The computed imaging analysis on the area of peridural scar tissue was also performed at 6 weeks postoperatively.RESULTS AND CONCLUSION：Severe peridural adhesion was formed in the model group,slight adhesion formed in the urokinase and autogenous fat particle groups,but no obvious adhesion formed in the autogenous fat particle＋ urokinase group.The number of fibroblasts was dramatically lower in the urokinase,autogenous fat particle and autogenous fat particle＋ urokinase groups than those in the model group （P0.05）,especially lowest in the autogenous fat particle＋ urokinase group （P0.05）.Compared with the model group,the area of peridural scar tissues were significant lower in the urokinase,autogenous fat particle and autogenous fat particle＋ urokinase groups （P0.05）,lowest in the autogenous fat particle＋ urokinase group.The autogenous fat particle combined with the urokinase has the best preventive effect on the peridural adhesion after laminectomy.