CAJ | 학술논문

目的探讨应用经皮穿刺技术向椎管内置入球囊导尿管致急性脊髓压迫性损伤动物模型的方法.方法 12只崇明山羊分为对照组(A组)、0.5 ml压迫组(B组)和1 ml压迫组(C组).选择腰-骶椎板间隙体表投影处为穿刺点,局麻后使用血管经皮穿刺鞘管,将5Fr球囊导尿管输送至硬膜外腔,透视下确认导尿管头端到达T6水平.1周后分别以0.5和1 ml容量扩张B、C组导尿管球囊,持续压迫脊髓30 min后撤除.各组动物均在穿刺操作及球囊扩张前后接受CT和MRI检查,计算球囊导管的椎管侵占率,并采用改良Tarlov评分评估神经功能.分别于球囊扩张后48 h及72 h处死每组各2只动物,取压迫节段脊髓送检病理.结果所有动物均顺利置管.CT测得置管后A～C组椎管侵占率依次为6.8％±0.7％、6.7％±0.7％和6.6％±0.6％.扩张球囊后B、C组椎管内侵占率分别增加到43.4％±2.5％和88.1％ ±2.3％;MRI提示球囊扩张后对脊髓腹侧右侧半形成压迫.置管后各组动物神经功能无明显受损,球囊扩张后B、C组出现后肢运动障碍.除A组外,病理检查显示球囊扩张压迫48 h后,相应节段脊髓呈现灰质内神经元胞体缩小,数量减少,胞体周围间隙增大,白质轻度脱髓鞘,部分轴突空泡样变;压迫72 h后病理改变明显加重.结论球囊扩张后神经、影像和病理学的评估结果符合急性脊髓压迫性损伤的特点.经皮穿刺置管技术能够避免破坏脊髓正常生理环境,模拟符合临床实际的闭合损伤机制,是一种可行性较高的脊髓损伤建模方法.
목적 탐토응용경피천자기술향추관내치입구낭도뇨관치급성척수압박성손상동물모형적방법.방법 12지숭명산양분위대조조(A조)、0.5 ml압박조(B조)화1 ml압박조(C조).선택요-저추판간극체표투영처위천자점,국마후사용혈관경피천자초관,장5Fr구낭도뇨관수송지경막외강,투시하학인도뇨관두단도체T6수평.1주후분별이0.5화1 ml용량확장B、C조도뇨관구낭,지속압박척수30 min후철제.각조동물균재천자조작급구낭확장전후접수CT화MRI검사,계산구낭도관적추관침점솔,병채용개량Tarlov평분평고신경공능.분별우구낭확장후48 h급72 h처사매조각2지동물,취압박절단척수송검병리.결과 소유동물균순리치관.CT측득치관후A～C조추관침점솔의차위6.8％±0.7％、6.7％±0.7％화6.6％±0.6％.확장구낭후B、C조추관내침점솔분별증가도43.4％±2.5％화88.1％ ±2.3％;MRI제시구낭확장후대척수복측우측반형성압박.치관후각조동물신경공능무명현수손,구낭확장후B、C조출현후지운동장애.제A조외,병리검사현시구낭확장압박48 h후,상응절단척수정현회질내신경원포체축소,수량감소,포체주위간극증대,백질경도탈수초,부분축돌공포양변;압박72 h후병리개변명현가중.결론 구낭확장후신경、영상화병이학적평고결과부합급성척수압박성손상적특점.경피천자치관기술능구피면파배척수정상생리배경,모의부합림상실제적폐합손상궤제,시일충가행성교고적척수손상건모방법.
Objective To establish a goat model of acute spinal cord compression injury through a modified percutaneous technique with a Foley double-lumen urine catheter and explore the method feasibility and preliminary observation.Methods Twelve adult male Chongming goats were randomly divided into 3 groups:control (A,n =4),0.5 ml compression (B,n =4) and 1 ml compression (C,n =4).After local anesthesia,all animals received epidural balloon catheter (5Fr) insertion via a percutaneous trans-lumbosacral interlaminar space technique that mimicked the method used in vascular access for angiography.The balloon catheter was advanced under fluoroscopic guidance until its distal tip reached the middle of T6 level.One week later,for groups B and C,the balloon was inflated by half-strength contrast material,0.5 ml and 1 ml,respectively.The balloon was left inflated for 30 min and then deflated.The images of computed tomography (CT) and magnetic resonance (MR) were taken before and after surgical procedures.Quantitative assessment of spine canal occupying rate was accomplished by an off-fine software program based on CT results.Motor function was assessed by the modified Tarlov scale.Two animals of each group were sacrificed after a total observation period of 48 h and 72 h respectively.Spinal cords from the injured level were then obtained for pathologic examinations.Results All animals underwent successful catheterization occupying 6.8％ ± 0.7％ (Group A),6.7％ ± 0.7％ (Group B) and 6.6％ ± 0.6％ (Group C) of spine canal respectively.After inflation,the occupying rate of groups B and C achieved 43.4％ ±2.5％ and 88.1％ ± 2.3％ respectively.Ventral compression of spinal cord was noted on MR images.Hindlimb movement remained normal after catheter insertion in all groups.All animals in group B and C became paraplegic after inflation.And a positive correlation existed between injection volume and Tarlov score.Pathological findings confirmed neuron atrophy,increased gap around neurons,mild demyelination and vacuolar degeneration both in groups B and C at 48 h after injury.Pathological changes deteriorated at 72 h after injury.Conclusion The results of behaviorial evaluation,radiographic images and pathological examination reveal an evidence of acute spinal cord injury.Percutaneous epidural balloon catheter insertion differs from previous techniques by avoiding surgical exposure and associated artifacts,yet it offers injury mechanisms similar to those of human spinal cord injury.As a new means of modeling spinal cord injury in animals,this technique has many potential applications.