中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2009年
8期
765-770
,共6页
真皮%移植,自体%硬膜
真皮%移植,自體%硬膜
진피%이식,자체%경막
Dermis%Transplantation,autologons%Dura mater
目的 探讨自体真皮移植预防硬膜外纤维化及粘连的效果,为临床应用提供实验依据.方法 选取5头西藏小型猪,手术切除L2、L4全椎板造成缺损,去除硬膜后方硬膜外脂肪暴露硬脊膜,切取自体真皮移植于L2椎板缺损处覆盖硬脊膜(实验组),L4椎板缺损处硬脊膜外不用任何移植物覆盖(自身空白对照组).于术后2、4、6、8、10周全麻下股动脉放血法各处死1头动物,大体观察移植真皮存活情况及是否存在毛发生长、皮脂腺和汗腺分泌物.采用改良Robertson记分法评定硬膜外瘢痕量及粘连程度,SPSS 13.0统计学软件进行统计分析.组织学观察移植真皮内皮肤附属器变化情况.结果 移植真皮全部成活,与体表真皮比较明显增厚(P<0.05).实验组未见移植真皮毛发生长、皮脂腺囊肿和汗液囊肿形成;真皮与硬脊膜之间存在潜在的易分离平面,只有极少量瘢痕组织,粘连疏松,硬膜表面和移植真皮表皮面光滑.对照组大量的瘢痕形成,竖脊肌前方瘢痕组织严重且广泛长人硬膜外腔,与硬脊膜粘连紧密,硬脊膜从瘢痕组织上分离困难.改良Robertson记分法评分,实验组硬膜外瘢痕量及粘连程度明显低于对照组(P<0.05).组织学观察见毛囊萎缩、毛根坏死、皮脂腺及汗腺消失.结论 自体真皮是一种具有良好的抑制瘢痕形成和物理隔离屏障作用的生物材料.自体真皮移植能有效地预防硬膜外纤维化及粘连,具有临床应用价值.
目的 探討自體真皮移植預防硬膜外纖維化及粘連的效果,為臨床應用提供實驗依據.方法 選取5頭西藏小型豬,手術切除L2、L4全椎闆造成缺損,去除硬膜後方硬膜外脂肪暴露硬脊膜,切取自體真皮移植于L2椎闆缺損處覆蓋硬脊膜(實驗組),L4椎闆缺損處硬脊膜外不用任何移植物覆蓋(自身空白對照組).于術後2、4、6、8、10週全痳下股動脈放血法各處死1頭動物,大體觀察移植真皮存活情況及是否存在毛髮生長、皮脂腺和汗腺分泌物.採用改良Robertson記分法評定硬膜外瘢痕量及粘連程度,SPSS 13.0統計學軟件進行統計分析.組織學觀察移植真皮內皮膚附屬器變化情況.結果 移植真皮全部成活,與體錶真皮比較明顯增厚(P<0.05).實驗組未見移植真皮毛髮生長、皮脂腺囊腫和汗液囊腫形成;真皮與硬脊膜之間存在潛在的易分離平麵,隻有極少量瘢痕組織,粘連疏鬆,硬膜錶麵和移植真皮錶皮麵光滑.對照組大量的瘢痕形成,豎脊肌前方瘢痕組織嚴重且廣汎長人硬膜外腔,與硬脊膜粘連緊密,硬脊膜從瘢痕組織上分離睏難.改良Robertson記分法評分,實驗組硬膜外瘢痕量及粘連程度明顯低于對照組(P<0.05).組織學觀察見毛囊萎縮、毛根壞死、皮脂腺及汗腺消失.結論 自體真皮是一種具有良好的抑製瘢痕形成和物理隔離屏障作用的生物材料.自體真皮移植能有效地預防硬膜外纖維化及粘連,具有臨床應用價值.
목적 탐토자체진피이식예방경막외섬유화급점련적효과,위림상응용제공실험의거.방법 선취5두서장소형저,수술절제L2、L4전추판조성결손,거제경막후방경막외지방폭로경척막,절취자체진피이식우L2추판결손처복개경척막(실험조),L4추판결손처경척막외불용임하이식물복개(자신공백대조조).우술후2、4、6、8、10주전마하고동맥방혈법각처사1두동물,대체관찰이식진피존활정황급시부존재모발생장、피지선화한선분비물.채용개량Robertson기분법평정경막외반흔량급점련정도,SPSS 13.0통계학연건진행통계분석.조직학관찰이식진피내피부부속기변화정황.결과 이식진피전부성활,여체표진피비교명현증후(P<0.05).실험조미견이식진피모발생장、피지선낭종화한액낭종형성;진피여경척막지간존재잠재적역분리평면,지유겁소량반흔조직,점련소송,경막표면화이식진피표피면광활.대조조대량적반흔형성,수척기전방반흔조직엄중차엄범장인경막외강,여경척막점련긴밀,경척막종반흔조직상분리곤난.개량Robertson기분법평분,실험조경막외반흔량급점련정도명현저우대조조(P<0.05).조직학관찰견모낭위축、모근배사、피지선급한선소실.결론 자체진피시일충구유량호적억제반흔형성화물리격리병장작용적생물재료.자체진피이식능유효지예방경막외섬유화급점련,구유림상응용개치.
Objective To investigate the ability of auto-dermis grafts in the prevention of epidural fibrosis and adhesions, and provide reference for clinical application. Methods Five Tibet mini-pigs were used and laminectomy was performed in lumbar 2 and 4 segment. Dura was exposed and covered with auto-genous dermis grafts in lumbar 2 (the experimental group), without grafts in lumbar 4 (the autogeoous blank group). The specimens were observed grossly and histologically at 2, 4, 6, 8 and 10 weeks postoperatively. Epidural scar amount and adhere range was evaluated by modified Robertson scoring method and analyzed by SPSS 13.0. No sear and adhesion, 0 point; small amount scar and light-range adhesion, 1 point; medium sear and midrange adhesion, 2 pionts; bulk scar ang high-range adhesion, 3 pionts. Results All grafted dermis survived and thicken obviously than dermis in body surface (P< 0.05). Hair growth, sebaceous gland cyst and sweat cystogenesis were not observed. A larvaceous dissection abruption plane, little cicatricial tis-sue and adhesions rarefaction between dermis and dura were observed in the experimental group. Massive ei-catricial tissue from erector spinae filled in cavitas epiduralis was observed and dura was separated difficult-ly from cicatricial tissue in the autogeous blank group. Epidural scar amount and adhesion range in the ex-perimental group was significantly lower than the blank group (P< 0.05). Conclusion Dermis is a kind of favourable biomaterial with restraining cicatrisation and isolation barrier. Autogenous dermis grafts has the best effect on preventing peridural cicatrisation and adhesion after laminectomy.
