PREVENTING POSTLAMINECTOMY ADHESION - A NEW EXPERIMENTAL-MODEL
PREVENTING POSTLAMINECTOMY ADHESION - A NEW EXPERIMENTAL-MODEL
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DOI：
10.1097/00007632-199408150-00004
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发表时间：
1994-08-15
期刊：
影响因子：
3
通讯作者：
GARFIN, SR
中科院分区：
文献类型：
--
作者：
ABITBOL, JJ;LINCOLN, TL;GARFIN, SR
研究设计.通过量化瘢痕形成的生物力学效应的新动物模型，研究了各种间置膜预防硬膜外粘连的有效性。21只狗在接受双节段椎板切开、神经根探查和椎间盘损伤后，接受自体游离脂肪移植、透明质酸或无间置膜治疗。另外11只没有接受脊柱手术的狗作为对照动物。在任何脊柱手术之前，首先测量形成瘢痕的固有倾向的动物间变异性。脊柱手术后12周，每只犬的腰骶椎被整块收获用于硬膜外粘连极限载荷的生物力学测试。还计算了瘢痕硬度系数。背景资料概述。非手术对照组与脂肪移植物和无间置膜组相比，粘附极限载荷显著更小，但与透明质酸组相比则无差异。透明质酸在降低粘附极限载荷方面的有益作用得到证实，尽管与脂肪移植物组和无间置膜组没有达到统计学显著差异。四组间瘢痕硬度系数无差异。描述了一种新的实验模型，该模型允许客观的生物力学量化术后瘢痕的影响。测量神经根和硬脑膜粘连的极限载荷。测定胶原蛋白含量的生化测定也用于评估标准化手术损伤后动物间形成瘢痕的倾向。并与相关研究结果进行比较。研究结果表明，与使用脂肪移植物或无间置膜相比，透明质酸在降低椎板切开术、神经根探查术和椎间盘损伤后硬膜外粘连的生物力学强度方面具有有益作用。这些结果支持其他最近的研究，研究使用透明质酸治疗椎板切除术模型。术中硬膜外出血的不良后果也被证明。本研究中描述的新实验模型是可重复的，并允许客观量化术后粘连的影响，而不仅仅是测量其存在。建议透明质酸治疗的有益效果和游离脂肪移植物间置膜缺乏这种有益效果。避免活动性硬膜外出血的重要性也是显而易见的。
Study Design. The efficacy of various interpositional membranes for prevention of extradural adhesion was investigated by a new animal model that quantified the biomechanical effect of scar formation. Twenty-one dogs were treated with autologous free fat graft, hyaluronic acid or no interpositional membrane after undergoing two-level laminotomy, nerve root exploration, and disk injury. An additional 11 dogs that did not undergo spine surgeries served as control animals.Objectives. Inter-animal variability in inherent propensity to form scar was first measured before any spine surgery. Twelve weeks after spine surgery, the lumbosacral spine of each dog was harvested en bloc for biomechanical testing of extradural adhesion ultimate load. Scar stiffness coefficient was also calculated.Summary of Background Data. Adhesion ultimate load was significantly less in the nonoperative control group when compared with the fat graft and no interpositional membrane group, but not when compared with the hyaluronic acid group. A beneficial effect of hyaluronic acid in lowering adhesion ultimate load was demonstrated, although a statistically significant difference from the fat graft and no interpositional membrane groups was not reached. No difference in scar stiffness coefficient was found between the four groups.Methods. A new experimental model allowing objective biomechanical quantification of the effect of postop-erative scar was described. Ultimate load of adhesions to both nerve roots and dura was measured. A biochemical assay that determined collagen content was also used to assess inter-animal propensity to form scar after a standardized surgical insult. Results were compared with other relevant studies.Results. Findings suggest a beneficial effect of hyaluronic acid in decreasing the biomechanical strength of extradural adhesions following laminotomy, nerve root exploration, and disk injury when compared with use of fat graft or no interpositional membrane. These results support other recent investigations that study the use of hyaluronic acid treatment in a laminectomy model. The adverse consequence of intraoperative epidural bleeding was also demonstrated.Conclusions. The new experimental model described in the current study was reproducible and permitted objective quantification of the effect of postoperative adhesion rather than measuring its mere presence. A beneficial effect of hyaluronic acid treatment and a lack of such beneficial effect of free fat graft interpositional membrane was suggested. The importance of avoiding active epidural bleeding was also evident.