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Pathophysiology and pain mechanism of iatrogenic lumbar adhesive arachnoiditis, its prevention and treatment

医源性腰椎粘连性蛛网膜炎的病理生理、疼痛机制及防治

基本信息

批准号：
61480317
负责人：
TSUJI Haruo
金额：
$ 3.33万
依托单位：
Faculty of Medicine, Toyama Medical and Pharmaceutical University
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1986
资助国家：
日本
起止时间：
1986 至 1988
项目状态：
已结题

项目摘要

This project concerns about clinical and basic studies on iatrogenic lumber abhesive arachnoiditis (ALL), with the causes, symptomatology, pathology, pain mechanism and pathomechanism of the arachnoid cell proliferation.The result are summarized as follows; 1) LAA was mainly caused by myelography and posterior surgical intervention, and the incidence was approximately 1.2% in low-back pain patients. Iatrogenic LAA was not infrequently observed in patients with degenerative spinal stenosis in the elderly, but it limited in slight adhesive arachnoiditis.2) Symptoms were mainly corresponded to multiroots irritation, paresthesia and palsies with a bizarre pattern and changing with the time. Patients had a tendency to reveal specific pain behavior and emotional abnormalities.3) A new stage and myelographic type classifications were drawn from the intraoperative findings, histology and the clinical examinations.4) Cathecolamine and serotonin metabolites in the CSF were analyzed by HPLC in 191 low-back pain / myelogathy patients including 13 cases with typical LAA. DOPAC and 3-MT were very high irrespective of puncture site in LAA patients, suggesting a combination of disorders of of brain metabolism. No epinephrine abnormality was detected in LAA.5) Through the arachnoid cell culture system, conditions inducing sbnormal proliferation of the arachnoid cell has been investigated including basic growth curve and DNA synthesis of the cells. The cells showed a phagocytosis and high synthesis capacity of DNA at 6-day culture. This study is further performing on influences of interlenkins, superoxides, various inflammatory products and foreign bodies on the cell pathology in the tissue culture system.6) A new surgical procedure was developed for patients with lumbar spinal stenosis accompanied by LAA.

本课题对医源性腰椎粘连性蛛网膜炎(ALL)的病因、症状学、病理学、疼痛机制和蛛网膜下腔细胞增殖的病理机制进行了临床和基础研究，主要结果如下：1)LAA主要由脊髓造影术和后路手术引起，在腰痛患者中的发病率约为1.2%。医源性LAA在老年退行性椎管狭窄患者中并不少见，但仅限于轻微的粘连性蛛网膜炎。2)症状主要对应于多根刺激、感觉异常和麻痹，其模式奇怪，且随时间变化。对191例下腰痛/脊髓病患者的脑脊液中的长春新碱和5-羟色胺代谢产物进行了高效液相色谱分析。LAA患者的DOPAC和3-MT水平与穿刺点无关，提示合并脑代谢紊乱。5)通过蛛网膜细胞培养体系，研究了诱导蛛网膜细胞正常增殖的条件，包括细胞的基本生长曲线和DNA合成。培养6d后，细胞表现出吞噬功能和较高的DNA合成能力。本研究进一步研究了组织培养体系中白介素类、超氧化物类、多种炎性物质和异物对细胞病理学的影响。6)为腰椎管狭窄症合并LAA患者制定了一种新的手术方法。