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Application of polyvinyl alcohol hydrogel (PVAH) membrane as anti-adhesive interposition after spinal surgery

聚乙烯醇水凝胶（PVAH）膜作为脊柱手术后防粘连介入物的应用

基本信息

批准号：
05671234
负责人：
HARAIZUMI Yutaka
金额：
$ 1.02万
依托单位：
Showa University
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (C)
财政年份：
1993
资助国家：
日本
起止时间：
1993 至 1994
项目状态：
已结题

项目摘要

A major concern after laminectomy is scar tissue formation which may result in extradural compression or make subsequent surgery to the same area difficult and hazardous. The main purpose of this study was to investigateate the usefulness of a polyvinyl alcohol hydrogel (PVAH) sheet as an interposition over the dura to prevent inflammatory and adhesive reaction after laminectomy. Wide laminectomy was performed at L5 in 60 adult cats. The dura was covered with PVAH sheet, free fat graft or without any interposition as a control. Animals were sacrificed at 3,12 weeks or 1 year. In the control group, adhesion of the exposed dura was apparent. Thick fibrous connective tissue formation was observed between the dura and the paravertebral muscles. In the fat graft group, the dura was separated from the scar tissue by living grafted fat. However, the dura was adherent to the grafted fat and fibroblasts migrated into the interstitial space. In the PVAH group, only a thin synovium-like layr was formed around the PVAH sheet. PVAH is made of water and alcohol, and has been shown to be non-toxic to tissue. This is permeable to low molecular weight but impermeable to large cells such as fibroblasts, thus the PVAH sheet prevents migration of inflammatory cells, and subsequently reduces intraspinal canal scar tissue dormation and adhesive reaction. Other beneficial properties are extreme elasticity and low friction which in eliminate mechanical reaction to the spinal cord. It is felt that the PVAH sheet is useful eliminating scar tissue formation and does not interfere with the dynamic gliding movement of the spinal cord and nerve roots.

椎板切除术后的一个主要问题是瘢痕组织的形成，这可能导致硬膜外压迫或使后续对同一区域的手术变得困难和危险。本研究的主要目的是探讨聚乙烯醇水凝胶（PVAH）片在硬脑膜上的作用，以防止椎板切除术后的炎症和粘连反应。在60只成年猫的L5处进行了广泛的椎板切除术。硬脑膜覆盖PVAH片，游离脂肪移植或无任何干预作为对照。动物分别于3周、12周和1岁时处死。对照组外露硬脑膜粘连明显。硬脑膜与椎旁肌肉间可见厚纤维结缔组织形成。脂肪移植组采用活体移植脂肪将硬脑膜与瘢痕组织分离。然而，硬脑膜粘附在移植脂肪上，成纤维细胞迁移到间质空间。在PVAH组，PVAH片周围仅形成薄滑膜样层。PVAH是由水和酒精制成的，已被证明对组织无毒。这对低分子量的细胞是可渗透的，但对大细胞如成纤维细胞是不可渗透的，因此PVAH片可以防止炎症细胞的迁移，并随后减少椎管内瘢痕组织的形成和粘附反应。其他有益的特性是极端的弹性和低摩擦，这消除了脊髓的机械反应。认为PVAH片是有用的消除瘢痕组织的形成，不干扰脊髓和神经根的动态滑动运动。