损伤控制手术治疗兔脊髓压迫性损伤的效果

发布时间：2019-06-16 19:05

【摘要】：目的:探讨损伤控制手术(damage control operation)治疗兔脊髓压迫性损伤的效果。方法:应用球囊压迫法制备新西兰大白兔脊髓压迫损伤模型45只,造模术后2d随机取5只完成行为学观测、评分后取出损伤区脊髓组织进行流式细胞仪凋亡细胞检测、病理学观察、免疫组化染色检测兔损伤区脊髓组织中基质金属蛋白酶2(MMP-2)表达(对照组),剩余40只随机分为两组,每组20只,一组采用损伤控制手术(A组),即减压术前先将球囊内压力减为原来一半,使椎管内有效容积增加后再自远离脊髓压迫较重的一侧进行全椎板减压;另一组直接予全椎板切除减压,减压自压迫最严重部位开始(B组),两组减压完毕后均取出球囊,并在减压术后1d、3d、7d、14d分别随机取5只实验兔完成以上检测内容。结果:对照组造模术后48h的Tarlov评分为1.20±0.45分,A、B组减压术后1d时Tarlov评分与对照组比较均无统计学差异(P0.05);A、B组减压术后1d、3d、7d时的Tarlov评分均无统计学差异(P0.05),减压术后14d时A组高于B组(P0.05)。对照组脊髓细胞凋亡率为(2.66±1.40)%,A、B组减压术后1d时脊髓细胞凋亡率均低于对照组(P0.05);减压术后1d、3d时A、B两组损伤区脊髓细胞凋亡率无统计学差异(P0.05);A、B组减压术后1d与3d、7d与14d损伤区脊髓细胞凋亡率无统计学差异(P0.05);A、B组减压术后3d与7d损伤区脊髓细胞凋亡率均有统计学差异(P0.05);减压术后7d、14d时A组损伤区脊髓细胞凋亡率均低于同时间点B组(P0.05)。病理学观察显示对照组白质轻度脱髓鞘、部分轴突空泡样变,灰质内细胞水肿,A、B组减压术后1d、3d、7d、14d白质弥漫性脱髓鞘改变及散在点状出血,灰质内细胞水肿伴神经细胞变性逐渐加重,至减压术后7d时灰质内广泛神经细胞变性,并持续到术后14d。对照组MMP-2表达阳性细胞率为(45.76±0.75)%,A、B组减压术后1d时MMP-2表达阳性率均低于对照组(P0.05);减压术后1d、3d、7d、14d时B组MMP-2表达阳性细胞率均高于同时间点A组(P0.05),A、B组减压术后1d、3d比较均无统计学差异(P0.05),3d、7d,7d、14d比较均有统计学差异(P0.05)。结论:损伤控制手术治疗兔脊髓压迫性损伤较直接减压效果好,建议对胸腰椎爆裂骨折合并脊髓压迫损伤的治疗采用损伤控制手术方案。
[Abstract]:Objective: to investigate the effect of injury control operation (damage control operation) in the treatment of spinal cord compression injury in rabbits. Methods: 45 New Zealand white rabbits with spinal cord compression injury were established by balloon compression method. 5 rabbits were randomly selected for behavioral observation 2 days after operation. After scoring, the injured spinal cord tissue was taken out for flow cytometry to detect apoptotic cells. Pathological observation, Immunohistochemical staining was used to detect the expression of matrix metalloprotease 2 (MMP-2) in spinal cord tissue of rabbits. The remaining 40 rabbits were randomly divided into two groups. In each group, 20 rats in each group were treated with injury control operation (group A), that is, the pressure in the balloon was reduced to half before decompression, and the effective volume in the spinal canal was increased, and then the total lamina decompression was performed from the side away from the compression of the spinal cord. The other group was directly treated with total laminectomy and decompression from the most serious part of compression (group B). The balloon was taken out after decompression in both groups, and 5 experimental rabbits were randomly selected on the 1st day, 3rd day, 7th day and 14th day after decompression. Results: the Tarlov score of control group was 1.20 卤0.45. there was no significant difference in Tarlov score between group B and control group on the 1st day after decompression (P 0.05). There was no significant difference in Tarlov score between group B and group B on the 1st day, 3rd day and 7th day after decompression (P 0.05), and the score of Tarlov in group A was higher than that in group B on the 14th day after decompression (P 0.05). The apoptosis rate of spinal cord cells in control group was (2.66 卤1.40)%. The apoptosis rate of spinal cord cells in group B was lower than that in control group on the 1st day after decompression (P 0.05), and there was no significant difference in the apoptosis rate of spinal cord cells between group B and group B on the 1st and 3rd day after decompression (P 0.05), but there was no significant difference in the apoptosis rate of spinal cord cells between group B and group B on the 1st and 3rd day after decompression, and there was no significant difference between group B and group B on the 7th day and 14th day after decompression (P 0.05). The apoptosis rate of spinal cord cells in group B was significantly lower than that in group B at 3 days and 7 days after decompression (P 0.05), and the apoptosis rate of spinal cord cells in group A was lower than that in group B at 14 days after decompression (P 0.05). Pathological observation showed mild demyelination of white matter, partial axonal vacuolation, gray matter cell edema, A, group B, 1 day, 3 days, 7 days, 14 days after decompression, white matter diffusely demyelination and scattered punctate hemorrhage, gray matter cell edema with nerve cell degeneration gradually aggravated, to decompression 7 days after decompression, extensive nerve cell degeneration in gray matter, and lasted until 14 days after decompression. The positive rate of MMP-2 expression in control group was (45.76 卤0.75)%. The positive rate of MMP-2 expression in group B was lower than that in control group at 1 day after decompression (P 0.05). On the 1st day, 3rd day, 7th day, 14th day after decompression, the positive cell rate of MMP-2 expression in group B was higher than that in group A at the same time point (P 0.05). There was no significant difference on the 1st day, 3rd day, 7th day, 14th day and 14th day after decompression in group A. there was no significant difference between group B and group B on the 1st day, 7th day and 14th day after decompression (P 0.05). Conclusion: injury control surgery is better than direct decompression in the treatment of spinal cord compression injury in rabbits. It is suggested that injury control operation should be used in the treatment of thoracolumbar burst fracture complicated with spinal cord compression injury.
【作者单位】：安徽医科大学新疆临床学院;新疆维吾尔自治区人民医院脊柱外科;武警江苏总队南京医院;
【基金】：新疆维吾尔自治区自然科学基金面上项目(2014211A060)
【分类号】：R651.2

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