Iannotti Christopher, Zhang Y Ping, Shields Lisa B E, Han Yingchun, Burke Darlene A, Xu Xiao-Ming, Shields Christopher B
Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, University of Louisville School of Medicine Louisville, Kentucky 40292, USA.
J Neurotrauma. 2006 Jun;23(6):853-65. doi: 10.1089/neu.2006.23.853.
This study examined whether duraplasty after acute cervical laceration spinal cord injury (SCI) in a rat model could (1) improve cerebrospinal fluid (CSF) circulation adjacent to the injury; (2) minimize connective tissue scarring; and (3) reduce post-traumatic inflammation and cystic cavitation. Following a transverse dural/arachnoid incision and C5-6 dorsal spinal hemisection, a 5-mm2 cadaveric dura mater allograft was placed over the lesion and fixed with fibrin glue (n=12). Control animals received an identical dural/arachnoid incision and cervical dorsal hemisection without dural repair (n=12). At 1, 5, and 10 weeks post-injury, plain film myelograms were obtained to characterize CSF circulation, and stereological methods were used to compare the extent of tissue sparing between the two groups. Immunohistochemical studies were performed to assess the degree of inflammation (ED-1), connective tissue scarring (laminin and type IV collagen), and reactive astrogliosis (GFAP). Our results indicate that dural allograft can improve CSF flow adjacent to the site of injury, which may be due to reduced meningeal fibrosis/scarring at the lesion site. Stereological analysis demonstrated that duraplasty resulted in a significant reduction in lesion volume at each time-point (p<0.01) associated with a nearly complete attenuation of post-traumatic cystic cavitation (p<0.001). Immunofluorescence studies demonstrated that duraplasty reduced the infiltration of ED-1-positive macrophages/microglia into and surrounding the lesion site, which may be responsible for the marked reduction in secondary injury following duraplasty. We conclude that duraplasty following acute spinal cord laceration may (1) improve CSF flow by limiting meningeal fibrosis; (2) reduce connective tissue scar formation; and (3) attenuate macrophage accumulation and progressive secondary injury.
本研究探讨在大鼠急性颈髓裂伤脊髓损伤（SCI）模型中进行硬脊膜成形术是否能够：（1）改善损伤部位附近的脑脊液（CSF）循环；（2）使结缔组织瘢痕形成最小化；（3）减轻创伤后炎症反应和囊性空洞形成。在进行硬脊膜/蛛网膜横向切开及C5 - 6节段脊髓背侧半横断术后，将一块5平方毫米的同种异体硬脑膜移植片覆盖于损伤部位并用纤维蛋白胶固定（n = 12）。对照动物接受相同的硬脊膜/蛛网膜切开及颈髓背侧半横断术，但不进行硬脊膜修复（n = 12）。在损伤后1周、5周和10周，获取平片脊髓造影以描述CSF循环情况，并采用体视学方法比较两组间组织保留程度。进行免疫组织化学研究以评估炎症程度（ED - 1）、结缔组织瘢痕形成（层粘连蛋白和IV型胶原）以及反应性星形胶质细胞增生（GFAP）。我们的结果表明，硬脑膜同种异体移植可改善损伤部位附近的CSF流动，这可能是由于损伤部位的脑膜纤维化/瘢痕形成减少所致。体视学分析表明，硬脊膜成形术在每个时间点均导致损伤体积显著减小（p < 0.01），同时创伤后囊性空洞形成几乎完全减轻（p < 0.001）。免疫荧光研究表明，硬脊膜成形术减少了ED - 1阳性巨噬细胞/小胶质细胞向损伤部位及其周围的浸润，这可能是硬脊膜成形术后继发性损伤显著减轻的原因。我们得出结论，急性脊髓裂伤后进行硬脊膜成形术可能：（1）通过限制脑膜纤维化来改善CSF流动；（2）减少结缔组织瘢痕形成；（3）减轻巨噬细胞积聚和进行性继发性损伤。
