不同硬膜外覆蓋物預(yù)防腰椎手術(shù)后瘢痕粘連形成的實驗研究
發(fā)布時間：2018-07-24 17:18
【摘要】：[研究目的]評價使用不同硬膜外覆蓋物對腰椎術(shù)后硬膜囊周圍瘢痕粘連形成的程度和影響因素,并初步探討其機制。[研究方法]將Wistar大鼠80只采用隨機數(shù)字表法隨機分為四組,實驗1組(使用膠原海綿加地塞米松)；實驗2組(單純使用膠原海綿)；實驗3組(使用明膠海綿)：對照組(無任何硬脊膜外覆蓋物),每組實驗動物20只,麻醉后在背部正中做切口行L1-L5全椎板切除,造成0.2cm×1.5cm骨性缺損,顯露硬脊膜囊。實驗1組動物硬膜外放置膠原海綿并注射0.1ML地塞米松,實驗2組動物硬膜外放置膠原海綿,實驗3組動物硬膜外放置明膠海綿,然后用顯微器械縫合肌肉層和筋膜層,對和傷口,對照組則直接縫合肌肉筋膜組織關(guān)閉傷口。統(tǒng)一常規(guī)喂養(yǎng)12周后從原始切口重新切開,觀察硬膜外瘢痕形成狀況及其與硬脊膜粘連情況,并使用改良Rydell-balazs標(biāo)準(zhǔn)和改良Nuss-baum標(biāo)準(zhǔn)進行量化評定。將實驗動物分組處死后,使用顯微外科手段采取手術(shù)區(qū)域的組織標(biāo)本,應(yīng)用免疫組化檢測和Western blot檢測顯示硬膜外瘢痕及周圍組織中TGF-β1、VEGF表達情況,比較各實驗組間差異。[結(jié)果]所有試驗動物在研究過程中無意外死亡發(fā)生,硬膜外瘢痕組織應(yīng)用Rydell-balazs評分結(jié)果顯示：實驗1組和實驗2組與對照組相比差異有顯著統(tǒng)計學(xué)意義(P0.01),與實驗3組相比差異有顯著統(tǒng)計學(xué)意義(P0.01),而實驗1組與實驗2組間差異無統(tǒng)計學(xué)意義(P0.05),實驗3組與對照組之間差異無顯著意義(P0.05)；應(yīng)用改良Nuss-baum標(biāo)準(zhǔn)評分,結(jié)果顯示實驗1組和實驗2組與對照組相比差異有顯著統(tǒng)計學(xué)意義(P0.01),與實驗3組相比差異有顯著統(tǒng)計學(xué)意義(P0.01),而實驗1組與實驗2組間差異無統(tǒng)計學(xué)意義(P0.05),實驗3組與對照組之間差異無顯著意義(P0.05)。免疫組化結(jié)果顯示TGF-β1和VEGF在四組標(biāo)本中均有陽性表達,但在實驗1組和2組中表達顯著低于較實驗3組和對照組,應(yīng)用光密度分析顯示：實驗1組和實驗2組與對照組相比差異有顯著統(tǒng)計學(xué)意義(P0.01)、與實驗3組相比差異有顯著統(tǒng)計學(xué)意義(P0.01)；而實驗1組與實驗2組間差異無統(tǒng)計學(xué)意義(P0.05)。實驗3組與對照組之間差異無顯著意義(P0.05)；Western blot檢測顯示TGF-β1和VEGF蛋白在四組標(biāo)本中均有陽性表達,但在實驗1組和實驗2組中的表達明顯低于較實驗3組和對照組,應(yīng)用光密度分析顯示：實驗1組和實驗2組與對照組相比有顯著差異(P0.01)、與實驗3組相比有顯著差異(PO.01)；而實驗1組與實驗2組間相比無顯著差異(P0.05)。實驗3組與對照組之間相比差異無顯著差異(PO.05)。[研究結(jié)論]膠原海綿可以顯著降低實驗大鼠腰椎術(shù)后硬膜周圍瘢痕增生粘連的形成,同時加用局部注射地塞米松并沒有加強這種作用；明膠海綿的局部應(yīng)用并不能達到預(yù)防硬膜外瘢痕粘連的目的。膠原海綿應(yīng)用后局部的TGF-β1和VEGF的低表達可能是減少硬膜外瘢痕增生粘連的重要機制之一。
[Abstract]:[objective] to evaluate the effect of different epidural coverings on the formation of scar adhesion around dural sac after lumbar surgery, and to explore its mechanism. [methods] Eighty Wistar rats were randomly divided into four groups: group 1 (using collagen sponge plus dexamethasone), group 2 (using collagen sponge alone), group 1 (treated with collagen sponge), group 2 (using collagen sponge alone), group 1 (treated with collagen sponge plus dexamethasone); Experimental group 3 (using gelfoam): control group (without any epidural covering), each group of 20 experimental animals, after anesthesia in the middle of the back incision L1-L5 total laminectomy, resulting in 0.2cm 脳 1.5cm bone defect, exposed dural sac. In group 1, collagen sponge was placed in epidural and injected with 0.1ML dexamethasone, collagen sponge was placed in epidural in experimental group 2, gelatin sponge was placed in epidural in experimental group 3, muscle layer and fascia layer were sutured with microinstruments. On the other hand, the control group directly sutured the muscle fascia tissue to close the wound. After 12 weeks of conventional feeding, the incision was performed from the original incision to observe the formation of epidural scar and its adhesion to the dura dural. The modified Rydell-balazs standard and modified Nuss-baum standard were used to evaluate quantitatively. After the experimental animals were divided into groups, the tissue samples in the surgical area were taken by microsurgery. The expression of TGF- 尾 _ 1 in the epidural scar and surrounding tissues was detected by immunohistochemistry and Western blot detection, and the differences between the two groups were compared. [results] No accidental death occurred in all experimental animals during the course of the study. The Rydell-balazs score of epidural scar tissue showed that there was significant difference between experimental group 1 and experimental group 2 and control group (P0.01), and there was significant difference between group 1 and group 2 (P0.01), while group 1 and group 2 showed significant difference in comparison with group 3 (P0.01). There was no significant difference between the two groups (P0.05), but there was no significant difference between the experimental group and the control group (P0.05). Using modified Nuss-baum standard score, The results showed that there was significant difference between group 1 and group 2 (P0.01), and between group 1 and group 3 (P0.01), but there was no significant difference between group 1 and group 2 (P0.05). There was no significant difference between the three groups and the control group (P0.05). Immunohistochemical results showed that TGF- 尾 1 and VEGF were positive in all four groups, but the expression of TGF- 尾 1 and VEGF in experimental group 1 and group 2 were significantly lower than those in experimental group 3 and control group. The results of optical density analysis showed that there were significant differences between experimental group 1 and control group (P0.01), and between group 1 and group 2 (P0.01), but there was no significant difference between group 1 and group 2 (P0.05). There was no significant difference between experimental group 3 and control group (P0.05) Western blot analysis showed that TGF- 尾 1 and VEGF protein were positive in all four groups, but the expression of TGF- 尾 1 and VEGF protein in group 1 and group 2 were significantly lower than those in group 3 and control group. The results of optical density analysis showed that there were significant differences (P0.01) and PO.01 (P0.01) between experimental group 1 and group 2, but no significant difference between group 1 and group 2 (P0.05). There was no significant difference (PO.05) between experimental group 3 and control group. [conclusion] Collagen sponge can significantly reduce the formation of peridural scar hyperplasia and adhesion after lumbar surgery in experimental rats, and the addition of local injection of dexamethasone does not enhance this effect. Local application of gelatin sponge can not prevent epidural scar adhesion. The low expression of TGF- 尾 1 and VEGF may be one of the important mechanisms to reduce the adhesion of epidural scar.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R687.3
本文編號：2142089
[Abstract]:[objective] to evaluate the effect of different epidural coverings on the formation of scar adhesion around dural sac after lumbar surgery, and to explore its mechanism. [methods] Eighty Wistar rats were randomly divided into four groups: group 1 (using collagen sponge plus dexamethasone), group 2 (using collagen sponge alone), group 1 (treated with collagen sponge), group 2 (using collagen sponge alone), group 1 (treated with collagen sponge plus dexamethasone); Experimental group 3 (using gelfoam): control group (without any epidural covering), each group of 20 experimental animals, after anesthesia in the middle of the back incision L1-L5 total laminectomy, resulting in 0.2cm 脳 1.5cm bone defect, exposed dural sac. In group 1, collagen sponge was placed in epidural and injected with 0.1ML dexamethasone, collagen sponge was placed in epidural in experimental group 2, gelatin sponge was placed in epidural in experimental group 3, muscle layer and fascia layer were sutured with microinstruments. On the other hand, the control group directly sutured the muscle fascia tissue to close the wound. After 12 weeks of conventional feeding, the incision was performed from the original incision to observe the formation of epidural scar and its adhesion to the dura dural. The modified Rydell-balazs standard and modified Nuss-baum standard were used to evaluate quantitatively. After the experimental animals were divided into groups, the tissue samples in the surgical area were taken by microsurgery. The expression of TGF- 尾 _ 1 in the epidural scar and surrounding tissues was detected by immunohistochemistry and Western blot detection, and the differences between the two groups were compared. [results] No accidental death occurred in all experimental animals during the course of the study. The Rydell-balazs score of epidural scar tissue showed that there was significant difference between experimental group 1 and experimental group 2 and control group (P0.01), and there was significant difference between group 1 and group 2 (P0.01), while group 1 and group 2 showed significant difference in comparison with group 3 (P0.01). There was no significant difference between the two groups (P0.05), but there was no significant difference between the experimental group and the control group (P0.05). Using modified Nuss-baum standard score, The results showed that there was significant difference between group 1 and group 2 (P0.01), and between group 1 and group 3 (P0.01), but there was no significant difference between group 1 and group 2 (P0.05). There was no significant difference between the three groups and the control group (P0.05). Immunohistochemical results showed that TGF- 尾 1 and VEGF were positive in all four groups, but the expression of TGF- 尾 1 and VEGF in experimental group 1 and group 2 were significantly lower than those in experimental group 3 and control group. The results of optical density analysis showed that there were significant differences between experimental group 1 and control group (P0.01), and between group 1 and group 2 (P0.01), but there was no significant difference between group 1 and group 2 (P0.05). There was no significant difference between experimental group 3 and control group (P0.05) Western blot analysis showed that TGF- 尾 1 and VEGF protein were positive in all four groups, but the expression of TGF- 尾 1 and VEGF protein in group 1 and group 2 were significantly lower than those in group 3 and control group. The results of optical density analysis showed that there were significant differences (P0.01) and PO.01 (P0.01) between experimental group 1 and group 2, but no significant difference between group 1 and group 2 (P0.05). There was no significant difference (PO.05) between experimental group 3 and control group. [conclusion] Collagen sponge can significantly reduce the formation of peridural scar hyperplasia and adhesion after lumbar surgery in experimental rats, and the addition of local injection of dexamethasone does not enhance this effect. Local application of gelatin sponge can not prevent epidural scar adhesion. The low expression of TGF- 尾 1 and VEGF may be one of the important mechanisms to reduce the adhesion of epidural scar.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R687.3
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