PLGA薄膜与生物蛋白胶联合应用对兔椎板切除术后硬膜外及神经根粘连的预防作用研究

摘要

目的探究聚乳酸-羟基乙酸共聚物（ PLGA）薄膜与生物蛋白胶联合应用对椎板切除术后硬膜外及神经根粘连的预防作用。方法应用随机数字表法将160只新西兰雄兔随机分为薄膜组、生物蛋白胶组、联合组、明胶组以及对照组，每组32只。薄膜组在硬膜裸露区覆盖PLGA薄膜；生物蛋白胶组在硬膜裸露区喷洒生物蛋白胶1 ml；联合组先在硬膜裸露区喷洒1 ml生物蛋白胶，待其充分吸收后，覆盖PLGA薄膜；明胶组在硬膜裸露区覆盖明胶海绵处理；对照组在相应部位的硬膜裸露区喷洒生理盐水。分析5组术后疤痕增生个数、切口愈合时间、发生炎症反应个数之间的差异。观察比较5组术后粘连程度以及粘连分级。在术后第2、8周比较各组的成纤维细胞个数以及神经根活动范围。结果5组在疤痕增生个数（χ2=2.06，P =0.84）、切口愈合时间（ F =0.91，P =0.46）、发生炎症反应个数（χ2=1.10， P =0.95）之间无显著差异。联合组的粘连程度较其他4组低（χ2=158.00，P ﹤0.01），硬膜外粘连分级等级低（χ2=160.00，P ﹤0.01）。术后第2、8周情况：联合组的成纤维细胞个数明显低于其余4组（ F =23.53，P ﹤0.01；F =142.20，P ﹤0.01）；联合组的神经根活动范围均高于其余4组（ F =70.90，P ﹤0.01；F =152.80，P ﹤0.01）。结论PLGA薄膜与生物蛋白胶联合应用对椎板切除术后硬膜外及神经根粘连具有预防作用，且不影响术后疤痕增生以及切口愈合。%Objective To explore the preventive effect of the combined application of PLGA thin film with fibrin glue on epidural and nerve root adhesion. Methods A total of 160 New Zealand male rabbits were randomly divided into film group,fibrin glue group,combined group,gelatin group and control group,32 cases in each group. The film group were covered with PLGA films in the bare dura mater;the fibrin glue group was sprayed 1 ml of fibrin glue in the bare dura mater;in the combined group:1 ml of fibrin glue was sprayed in the dura mater;gelatin group was covered with gelatin sponge in the exposed area of dura mater;the control group was sprayed with normal saline in the exposed area of dura mater. The postoperative scar hyperplasia number,wound healing time and inflammation of the number was observed in 5 groups. The adhe-sion degree and adhesion grade were observed and compared in five groups. The number of fibroblasts and the range of nerve root activity were com-pared at the 2nd and 8th week after operation. Results The number of scar hyperplasia(χ2 =2. 06,P =0. 84),wound healing time( F =0. 91, P =0. 46),the number of inflammatory reaction(χ2 =1. 10,P =0. 95)had no significant difference among the five groups. The adhesion degree of the combination group was lower than that of the other 4 groups(χ2 =158. 00,P ﹤0. 01),and epidural adhesion grade level was lower(χ2 =160. 00,P ﹤0. 01). The fibroblast number in 2 and 8 weeks of combined group were significantly lower than that of the other four groups( F =23. 53,P ﹤0. 01;F =142. 20,P ﹤0. 01). The nerve root activity in the combination group in 2 and 8 weeks were higher than that in the other four groups( F =70. 90,P ﹤0. 01;F =152. 80,P ﹤0. 01). Conclusion The combined application of PLGA thin film with fibrin glue on epi-dural and nerve root adhesion has a preventive effect. And it dose not affect the postoperative wound healing and scar hyperplasia.