Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions
Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions
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DOI：
10.1007/s00586-009-1013-x
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发表时间：
2009-08-01
影响因子：
2.8
通讯作者：
Fan, Hongbin
中科院分区：
文献类型：
--
作者：
Tao, Huiren;Fan, Hongbin
椎板切除术后硬膜外粘连被认为是“背部手术失败综合征”的主要原因，并且与翻修手术期间并发症风险增加相关。作为机械屏障以减少成纤维细胞浸润到硬膜外腔的各种材料取得了有限的成功。在本研究中，在犬模型中研究了羊膜（AM）以调查其对减少椎板切除术后硬膜外疤痕粘连的作用。椎板切除部位在 L-1、L-3、L-5 和将冻干AM（FAM）、交联AM（CAM）和自体游离脂肪（AFF）分别植入24只成年犬的随机指定部位，其余未处理部位作为内对照，然后在术后1、6和12周处死动物，然后比较包括疤痕数量和粘附强度的大体病理观察、定性组织学评估和定量组织学分析。肉眼观察发现，与FAM组和未治疗组相比，CAM组的疤痕数量和粘连强度显着降低，硬膜上覆盖有一层白色的、轻微血管化的CAM层，且没有顽强的疤痕粘连。组织学分析也表明，与AFF组的结果相似，CAM可有效减少硬膜外纤维化和疤痕粘连。它是一种有前景的未来临床应用的生物材料。
Postlaminectomy epidural adhesion is implicated as a main cause of "failed back surgery syndrome'' and associated with increased risk of complications during revision surgery. Various materials acting as mechanical barriers to reduce fibroblasts infiltration into epidural space have met with limited success. In present research, amniotic membrane (AM) was studied to investigate its effects on reducing epidural scar adhesion after laminectomy in a canine model. Laminectomy sites were created at L-1, L-3, L-5, and L-7 levels in 24 adult mongrel dogs. Freeze dried AM (FAM), cross-linked AM (CAM), and autologous free fat (AFF) were implanted, respectively, at a randomly assigned site in each dog with the remaining untreated site serving as internal control. The animals were sacrificed at 1, 6, and 12 weeks postoperatively. Then, gross pathologic observation including scar amount and adhesion tenacity, qualitative histology evaluation, and quantitative histology analysis were compared. Gross observation demonstrated that scar amount and adhesion tenacity of CAM group were significantly lower in comparison with those of FAM and non-treatment groups. A white, slightly vascularized CAM layer covered the dura mater without tenacious scar adhesion. The histology analysis also indicated reduced fibroblasts infiltration and consequent epidural fibrosis, which were similar to the results of AFF group. In conclusion, the CAM is effective in reducing epidural fibrosis and scar adhesion after laminectomy in canine model. It is a promising biomaterial for future clinical applications.