Klopp Lisa S, Toth Jeffrey M, Welch William C, Rao Sangeeta, Tai Joseph W, Thomas Kevin A, Turner Simon
Department of Clinical Sciences, Colorado State University, 300 West Drake Rd, Fort Collins, CO 80523, USA.
Spine J. 2009 May;9(5):411-7. doi: 10.1016/j.spinee.2009.01.001. Epub 2009 Mar 9.
The development of scar tissue and adhesions postoperatively is a natural consequence of healing but can be associated with medical complications and render reoperation difficult. Many biocompatible products have been evaluated as barriers or deterrents to adhesions.
To evaluate the efficacy of a bioresorbable polylactide film as a barrier to adhesion formation after anterolateral discectomy.
Experimental study.
Seven, skeletally mature female sheep underwent a retroperitoneal approach to the anterolateral lumbar spine. A discectomy was performed at two levels with an intervening unoperated disc site. One site was treated with a polylactide film barrier (Hydrosorb Shield; MacroPore Biosurgery, San Diego, CA) affixed with tacks manufactured from the same material. The second site was left untreated. Treatment and control sites were randomly assigned. Postmortem analysis included scar tenacity scoring on five spines and histological evaluation on two spines.
The application of the Hydrosorb film barrier allowed a definite dissection plane during scar tenacity scoring and there was a significant difference in the development of adhesions to the disc between the control and treated sites. Histological evaluation revealed evidence of barrier formation to scar tissue and no significant adverse inflammatory reactions.
Hydrosorb Shield appears to be an effective postoperative barrier to scar tissue adhesion after anterolateral discectomy. The use of polylactide tacks was beneficial to affix the barrier film in place. Safety issues associated with delayed healing or adverse response to the film or tacks were not observed. Hydrosorb film may be useful as an antiadhesion barrier facilitating dissection during surgical revision in anterior approaches to the spine. Further studies are indicated to evaluate the performance of the bioresorbable material as an antiadhesion barrier in techniques of spinal fusion and disc replacement.
术后瘢痕组织和粘连的形成是愈合的自然结果，但可能与医学并发症相关，并使再次手术变得困难。许多生物相容性产品已被评估为粘连的屏障或抑制剂。
评估一种可生物吸收的聚丙交酯膜在前外侧椎间盘切除术后作为粘连形成屏障的疗效。
实验研究。
7只骨骼成熟的雌性绵羊接受经腹膜后途径到达腰椎前外侧。在两个节段进行椎间盘切除术，中间有一个未手术的椎间盘节段。一个部位用由相同材料制成的大头钉固定聚丙交酯膜屏障（Hydrosorb Shield；MacroPore Biosurgery，圣地亚哥，加利福尼亚州）进行处理。第二个部位不进行处理。处理部位和对照部位随机分配。尸检分析包括对五个脊柱的瘢痕韧性评分和对两个脊柱的组织学评估。
在瘢痕韧性评分过程中，Hydrosorb膜屏障的应用使解剖平面明确，对照部位和处理部位与椎间盘粘连的发展存在显著差异。组织学评估显示有针对瘢痕组织的屏障形成证据，且无明显不良炎症反应。
Hydrosorb Shield似乎是前外侧椎间盘切除术后防止瘢痕组织粘连的有效术后屏障。使用聚丙交酯大头钉有助于将屏障膜固定到位。未观察到与延迟愈合或对膜或大头钉的不良反应相关的安全问题。Hydrosorb膜可能作为一种抗粘连屏障，有助于脊柱前路手术翻修时的解剖分离。需要进一步研究来评估这种可生物吸收材料在脊柱融合和椎间盘置换技术中作为抗粘连屏障的性能。
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