不同硬膜外覆盖物预防腰椎手术后瘢痕粘连形成的实验研究
发布时间：2018-07-24 17:18
【摘要】：[研究目的]评价使用不同硬膜外覆盖物对腰椎术后硬膜囊周围瘢痕粘连形成的程度和影响因素,并初步探讨其机制。[研究方法]将Wistar大鼠80只采用随机数字表法随机分为四组,实验1组(使用胶原海绵加地塞米松)；实验2组(单纯使用胶原海绵)；实验3组(使用明胶海绵)：对照组(无任何硬脊膜外覆盖物),每组实验动物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骨性缺损,显露硬脊膜囊。实验1组动物硬膜外放置胶原海绵并注射0.1ML地塞米松,实验2组动物硬膜外放置胶原海绵,实验3组动物硬膜外放置明胶海绵,然后用显微器械缝合肌肉层和筋膜层,对和伤口,对照组则直接缝合肌肉筋膜组织关闭伤口。统一常规喂养12周后从原始切口重新切开,观察硬膜外瘢痕形成状况及其与硬脊膜粘连情况,并使用改良Rydell-balazs标准和改良Nuss-baum标准进行量化评定。将实验动物分组处死后,使用显微外科手段采取手术区域的组织标本,应用免疫组化检测和Western blot检测显示硬膜外瘢痕及周围组织中TGF-β1、VEGF表达情况,比较各实验组间差异。[结果]所有试验动物在研究过程中无意外死亡发生,硬膜外瘢痕组织应用Rydell-balazs评分结果显示：实验1组和实验2组与对照组相比差异有显著统计学意义(P0.01),与实验3组相比差异有显著统计学意义(P0.01),而实验1组与实验2组间差异无统计学意义(P0.05),实验3组与对照组之间差异无显著意义(P0.05)；应用改良Nuss-baum标准评分,结果显示实验1组和实验2组与对照组相比差异有显著统计学意义(P0.01),与实验3组相比差异有显著统计学意义(P0.01),而实验1组与实验2组间差异无统计学意义(P0.05),实验3组与对照组之间差异无显著意义(P0.05)。免疫组化结果显示TGF-β1和VEGF在四组标本中均有阳性表达,但在实验1组和2组中表达显著低于较实验3组和对照组,应用光密度分析显示：实验1组和实验2组与对照组相比差异有显著统计学意义(P0.01)、与实验3组相比差异有显著统计学意义(P0.01)；而实验1组与实验2组间差异无统计学意义(P0.05)。实验3组与对照组之间差异无显著意义(P0.05)；Western blot检测显示TGF-β1和VEGF蛋白在四组标本中均有阳性表达,但在实验1组和实验2组中的表达明显低于较实验3组和对照组,应用光密度分析显示：实验1组和实验2组与对照组相比有显著差异(P0.01)、与实验3组相比有显著差异(PO.01)；而实验1组与实验2组间相比无显著差异(P0.05)。实验3组与对照组之间相比差异无显著差异(PO.05)。[研究结论]胶原海绵可以显著降低实验大鼠腰椎术后硬膜周围瘢痕增生粘连的形成,同时加用局部注射地塞米松并没有加强这种作用；明胶海绵的局部应用并不能达到预防硬膜外瘢痕粘连的目的。胶原海绵应用后局部的TGF-β1和VEGF的低表达可能是减少硬膜外瘢痕增生粘连的重要机制之一。
[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.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R687.3
本文编号：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.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R687.3
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