新型人工椎板预防后路椎板切除术后瘢痕粘连的实验研究_《中国修复重建外科杂志》

作者：

吕超亮 ^1,2 , 宋跃明 ¹ , 刘浩 ¹ , 刘立岷 ¹ , 龚全 ¹ , 李涛 ¹ , 曾建成 ¹ , 孔清泉 ¹ , 裴福兴 ¹ , 屠重棋 ¹ , 段宏 ¹

1四川大学华西医院骨科（成都，610041）;;
2济宁市第一人民医院骨科;

关键词：

纳米羟基磷灰石氨基酸共聚物人工椎板瘢痕组织椎板切除山羊

DOI：

10.7507/1002-1892.20130182

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的评价使用新型氨基酸聚合物（multi-amino-acid copolymer，MAACP）复合纳米羟基磷灰石（nano-hydroxyapatite，n-HA）人工椎板在山羊颈椎椎板切除术后阻隔硬膜外瘢痕粘连、压迫的应用价值。方法2岁龄雄性山羊15只，体重（30 ± 2）kg，随机分为实验组（n=9）和对照组（n=6）。实验组行C4椎板切除，MAACP/n-HA人工椎板植入；对照组仅行C4椎板切除。术后4、12、24周分别取实验组2、2、5只，对照组2、2、2只山羊，行大体观察伤口感染、人工椎板有无移位碎裂、椎管形状等，并根据大体观察Rydell瘢痕粘连程度评级标准评价两组手术节段粘连程度；行X线片、CT影像学观察，24周时测量C3、C4、C5椎管面积及椎管矢状径，以正常山羊（n=2）作为正常组；24周MRI观察脊髓神经是否受压；然后处死取材，行组织学观察。结果术后所有动物切口愈合良好，未见毒性及免疫排斥反应。术后实验组手术节段粘连程度明显优于对照组（Z= —2.52，P=0.00）。术后各时间点X线片及CT观察示实验组人工椎板位置无移位，外形完整，骨性椎管逐渐得到重建；对照组C4椎板及棘突缺损，软组织影突入椎管。术后24周，C4椎管面积和椎管矢状径实验组和正常组均显著高于对照组（P lt; 0.05），实验组与正常组比较差异无统计学意义（P gt; 0.05）。实验组MRI示C4平面脑脊液信号通畅，无软组织突入椎管，硬膜无粘连受压；对照组椎板缺损处瘢痕组织突入椎管与硬膜粘连，硬膜轻度受压。组织切片HE染色及Masson三色染色示实验组人工椎板完整无明显降解，人工椎板与自体骨结合界面周围少量成骨；对照组椎板缺损处纤维组织长入。结论新型MAACP/n-HA人工椎板可在体内长久维持生物力学稳定，对周围瘢痕向椎板缺损处生长有良好机械阻隔作用。

引用本文： 吕超亮,宋跃明,刘浩,刘立岷,龚全,李涛,曾建成,孔清泉,裴福兴,屠重棋,段宏. 新型人工椎板预防后路椎板切除术后瘢痕粘连的实验研究. 中国修复重建外科杂志, 2013, 27(7): 829-835. doi: 10.7507/1002-1892.20130182 复制

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13.	倪彬, 侯春林, 贾连顺, 等. 几丁质膜引导兔桡骨缺损骨再生的实验研究. 中华骨科杂志, 1995, 15(9): 607-609.
14.	Keskin F, Esen H. Comparison of the effects of an adhesion barrier and chitin on experimental epidural fibrosis. Turk Neurosurg, 2010, 20(4): 457-463.
15.	Jacobs RR, McClain O, Neff J. Control of postlaminectomy scar formation. An experimental and clinical study. Spine (Phila Pa 1976), 1980, 5(3): 223-229.
16.	Lladó A, Sologaistua E, Guimerá J, et al. Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: a clinical study. Eur Spine J, 1999, 8(2): 144-150.
17.	Wang J, Chen W, Li Y, et al. Biological evaluation of biphasic calcium phosphate ceramic vertebral laminae. Biomaterials, 1998, 19(15): 1387-1392.
18.	李玉宝. 纳米生物医药材料. 北京: 化学工业出版社, 2004: 36-40．.
19.	唐文胜, 蒋电明, 安洪, 等. 纳米羟基磷灰石/聚酰胺复合人工椎板预防脊柱后路术后椎管内瘢痕粘连的实验研究. 中国脊柱脊髓杂志, 2005, 15(11): 675- 678.
20.	蒋电明, 权正学, 黄伟, 等. 纳米羟基磷灰石/聚酰胺66复合生物活性人工椎板的初步临床应用. 中国修复重建外科杂志, 2007, 21(5): 441-444.
21.	周春光, 宋跃明, 屠重棋, 等. 可降解多元氨基酸共聚物/磷酸钙复合材料椎间融合器植入山羊颈椎即刻稳定性的生物力学评价. 生物医学工程学杂志, 2011, 28(1): 63-66.
22.	Yu C, Kohn J. Tyrosine-PEG-derived poly (ether carbonate)s as new biomaterials. Biomaterials, 1999, 20(3): 253-264.
23.	Rokkanen PU, Bostman O, Hirvensalo E, et al. Bioabsorbable fixation in orthopaedic surgery and traumatology. Biomaterials, 2002, 21(24): 2607-2613.
24.	Wei J, Li YB, Chen WQ, et al. A study on nano-composite of hydroxyapatite and polyamide. J Mater Sci, 2003, 38(15): 3303-3306．.
25.	Gupta HS, Seto J, Wagermaier W, et al. Cooperative deformation of mineral and collagen in bone at the nanoscale. Proc Natl Acad Sci U S A, 2006, 103(47): 17741-17746.
26.	Urist MR, Mclean FC. Recent advances in physiology of bone. J Bone Joint Surg (Am), 1963, 45: 1305-1313.
27.	Caroli E, Orlando ER, D’Andrea G, et al. Anterior cervical fusion with interbody titanium cage containing surgical bone site graft: our institution’s experience in 103 consecutive cases of degenerative spondylosis. Spinal Disord Tech, 2007, 20(3): 216-220.

1. LaRocco H, Macnab I. The laminectomy membrane. J Bone Joint Surg (Br), 1974, 56B(3): 545-550.
2. Bosscher HA, Heavner JE. Incidence and severity of epidural fibrosis after back surgery: an endoscopic study. Pain Pract, 2010, 10(1): 18-24.
3. Welch WC, Thomas KA, Cornwall GB, et al. Use of polylactide resorbable film as an adhesion barrier. J Neurosurg, 2002, 97(4 Suppl): 413-422.
4. Tang X, Yang SH, Xu WH, et al. Vertebral plate regeneration induced by radiation-sterilized allogeneic bone sheets in sheep. Chin J Traumatol, 2007, 10(1): 34-39.
5. Rydell NW, Balais EA. Effect of intra-articular injection of hyaluronic acid on the clinical sysnptoms of osteoarthritis and on granulation tissue formation. Clin Orthop Relat Res, 1971, 80: 25-32.
6. Ran B, Song YM, Liu H, et al. Novel biodegradable a-TCP/poly (amino acid) composite artificial lamina following spinal surgery for prevention of intraspinal scar adhesion. Eur Spine J, 2011, 20(12): 2240-2246.
7. Lawson KJ, Malycky J, Berry JL, et al. Lamina repair and replacement to control laminectomy membrane formation in dogs. Spine (Phila Pa 1976), 1991, 16(6 Suppl): S222-226.
8. Su C, Yao C, Lu S, et al. Study on the optimal concentration of topical mitomycin-C in preventing postlaminectomy epidural adhesion. Eur J Pharmacol, 2010, 640(1-3): 63-67.
9. Yu CH, Lee JH, Baek HR, et al. The effectiveness of poloxamer 407-based new anti-adhesive material in a laminectomy model in rats. Eur Spine J, 2012, 21(5) : 971-979.
10. Richards PJ, Turner AS, Gisler SM, et al. Reduction in postlaminectomy epidural adhesions in sheep using a fibrin sealant-based medicated adhesion barrier. J Biomed Mater Res B Appl Biomater, 2010, 92(2): 439-446.
11. Villavicencio AT, Nelson EL, Burneikiene S, et al. Surgical treatment strategies for the previously operated lumbar spine. Contemporary Spine Surgery, 2012, 13(1): 1-7.
12. 侯筱魁, 樊天佑. 透明质酸钠预防术后硬膜外粘连的组织学和超微结构研究. 中华骨科杂志, 1998, 18(5): 301-303.
13. 倪彬, 侯春林, 贾连顺, 等. 几丁质膜引导兔桡骨缺损骨再生的实验研究. 中华骨科杂志, 1995, 15(9): 607-609.
14. Keskin F, Esen H. Comparison of the effects of an adhesion barrier and chitin on experimental epidural fibrosis. Turk Neurosurg, 2010, 20(4): 457-463.
15. Jacobs RR, McClain O, Neff J. Control of postlaminectomy scar formation. An experimental and clinical study. Spine (Phila Pa 1976), 1980, 5(3): 223-229.
16. Lladó A, Sologaistua E, Guimerá J, et al. Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: a clinical study. Eur Spine J, 1999, 8(2): 144-150.
17. Wang J, Chen W, Li Y, et al. Biological evaluation of biphasic calcium phosphate ceramic vertebral laminae. Biomaterials, 1998, 19(15): 1387-1392.
18. 李玉宝. 纳米生物医药材料. 北京: 化学工业出版社, 2004: 36-40．.
19. 唐文胜, 蒋电明, 安洪, 等. 纳米羟基磷灰石/聚酰胺复合人工椎板预防脊柱后路术后椎管内瘢痕粘连的实验研究. 中国脊柱脊髓杂志, 2005, 15(11): 675- 678.
20. 蒋电明, 权正学, 黄伟, 等. 纳米羟基磷灰石/聚酰胺66复合生物活性人工椎板的初步临床应用. 中国修复重建外科杂志, 2007, 21(5): 441-444.
21. 周春光, 宋跃明, 屠重棋, 等. 可降解多元氨基酸共聚物/磷酸钙复合材料椎间融合器植入山羊颈椎即刻稳定性的生物力学评价. 生物医学工程学杂志, 2011, 28(1): 63-66.
22. Yu C, Kohn J. Tyrosine-PEG-derived poly (ether carbonate)s as new biomaterials. Biomaterials, 1999, 20(3): 253-264.
23. Rokkanen PU, Bostman O, Hirvensalo E, et al. Bioabsorbable fixation in orthopaedic surgery and traumatology. Biomaterials, 2002, 21(24): 2607-2613.
24. Wei J, Li YB, Chen WQ, et al. A study on nano-composite of hydroxyapatite and polyamide. J Mater Sci, 2003, 38(15): 3303-3306．.
25. Gupta HS, Seto J, Wagermaier W, et al. Cooperative deformation of mineral and collagen in bone at the nanoscale. Proc Natl Acad Sci U S A, 2006, 103(47): 17741-17746.
26. Urist MR, Mclean FC. Recent advances in physiology of bone. J Bone Joint Surg (Am), 1963, 45: 1305-1313.
27. Caroli E, Orlando ER, D’Andrea G, et al. Anterior cervical fusion with interbody titanium cage containing surgical bone site graft: our institution’s experience in 103 consecutive cases of degenerative spondylosis. Spinal Disord Tech, 2007, 20(3): 216-220.

《中国修复重建外科杂志》

新型人工椎板预防后路椎板切除术后瘢痕粘连的实验研究

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《中国修复重建外科杂志》

新型人工椎板预防后路椎板切除术后瘢痕粘连的实验研究

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