Lawson K J, Malycky J L, Berry J L, Steffee A D
Department of Orthopaedics, David Grant USAF Medical Center, Travis Air Force Base, California.
Spine (Phila Pa 1976). 1991 Jun;16(6 Suppl):S222-6. doi: 10.1097/00007632-199106001-00009.
This study examined the efficacy of lamina repair by the use of various techniques to prevent postlaminectomy scar formation in a canine system. Five-level noncontiguous laminectomies were performed on six adult canines. The most caudal (Site 1) was left uncovered and served as the control. Exposed dura at each of the remaining four levels was covered with one of the following: Site 2, free autogenous laminar bone graft; Site 3, polymethylmethacrylate; Site 4, Teflon-Proplast composite; Site 5, collagen gel. The dogs used in the study were killed 16 weeks after surgery. Three specimens were examined by plain roentgenography and computerized tomography, two specimens were examined histologically, and the remaining four specimens were graded according to scar volume and scar adherence, as detected during gross dissection of the postlaminectomy scar. No repair technique interfered with roentgenography evaluation. The least scar and fewest adhesions were present under the free bone graft repair site. The Teflon-Proplast composite and polymethylmethacrylate both limited the amount and adherence of scar. Collagen gel and control sites were indistinguishable in this study. It is concluded that lamina repair with a solid material covering exposed dura significantly reduces the formation of postlaminectomy membrane and scar.
本研究在犬类系统中检验了使用各种技术进行椎板修复以预防椎板切除术后瘢痕形成的疗效。对6只成年犬实施了五级非连续椎板切除术。最尾端的部位(部位1)未作覆盖,作为对照。其余四个部位暴露的硬脑膜分别用以下材料覆盖:部位2,自体游离椎板骨移植;部位3,聚甲基丙烯酸甲酯;部位4,聚四氟乙烯-普罗普拉斯复合材料;部位5,胶原凝胶。研究中使用的犬在术后16周处死。3个标本进行了X线平片和计算机断层扫描检查,2个标本进行了组织学检查,其余4个标本根据椎板切除术后瘢痕大体解剖时检测到的瘢痕体积和瘢痕粘连情况进行分级。没有修复技术干扰X线评估。自体游离骨移植修复部位的瘢痕最少,粘连也最少。聚四氟乙烯-普罗普拉斯复合材料和聚甲基丙烯酸甲酯都限制了瘢痕的数量和粘连。在本研究中,胶原凝胶部位和对照部位没有区别。得出的结论是,用固体材料覆盖暴露的硬脑膜进行椎板修复可显著减少椎板切除术后膜和瘢痕的形成。