颈椎损伤后硬脊膜内空间早期手术减压的作用：动物模型研究
Role of early surgical decompression of the intradural space after cervical spinal cord injury in an animal model.
机构信息
Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA.
出版信息
J Bone Joint Surg Am. 2010 May;92(5):1206-14. doi: 10.2106/JBJS.I.00740.
BACKGROUND
The role of decompressing the intradural space through a durotomy as a treatment option for acute traumatic cervical spinal cord injury has not been explored in an animal model, to our knowledge. We sought to determine the role of durotomy and duraplasty in the treatment of acute cervical spinal cord injury and its effects on inflammation, scar formation, and functional recovery.
METHODS
Seventy-two adult female Sprague-Dawley rats were assigned to three groups: contusion injury alone, contusion injury with a decompressive durotomy, and contusion injury with a decompressive durotomy followed by placement of a dural allograft. A mild (200-kdyn [2-N]) contusive injury was delivered to the exposed spinal cord at C5. The injured segment was reexposed four hours after injury, and a durotomy with decompression was performed. When a dural allograft was used it was affixed to the surrounding intact dura with use of a fibrin sealant. The Grip Strength Meter was used to assess forelimb function. Animals were killed at two and four weeks, and immunohistochemical analysis was performed to assess scar formation, inflammatory cell infiltration, and lesional volume.
RESULTS
Immunohistochemical analysis revealed increased scar formation, cavitation, and inflammatory response in the animals treated only with a decompressive durotomy. Relative to the group with a contusion injury alone, the animals treated with a durotomy followed by a dural allograft had decreased cavitation and scar formation. Lesional volume measurements showed a significantly increased cavitation size at four weeks in both the contusion-only (mean and standard deviation, 12.6 +/- 0.5 mm(3)) and durotomy-only (15.1 +/- 1 mm(3)) groups relative to the animals that had received a dural allograft following durotomy (6.8 +/- 1.4 mm(3)).
CONCLUSIONS
Functional recovery after acute cervical spinal cord injury was better in animals treated with decompression of the intradural space and placement of a dural allograft than it was in animals treated with decompression alone. These functional data correlated directly with histological evidence of a decrease in spinal cord cavitation, inflammation, and scar formation.
背景
据我们所知，在动物模型中，并未探索通过硬脊膜切开术来缓解硬脊膜内空间的压力作为急性创伤性颈脊髓损伤的治疗选择。我们试图确定硬脊膜切开术和硬脊膜成形术在急性颈脊髓损伤治疗中的作用及其对炎症、瘢痕形成和功能恢复的影响。
方法
72 只成年雌性 Sprague-Dawley 大鼠分为三组：单纯挫伤组、挫伤伴减压硬脊膜切开组和挫伤伴减压硬脊膜切开加硬脊膜同种异体移植组。在 C5 暴露的脊髓上施加轻度（200 达因[2-N]）挫伤伤。伤后 4 小时再次暴露损伤节段，进行硬脊膜切开减压。当使用硬脊膜同种异体移植物时，用纤维蛋白密封剂将其固定在周围完整的硬脊膜上。使用握力计评估前肢功能。动物在 2 周和 4 周时处死，进行免疫组织化学分析以评估瘢痕形成、炎症细胞浸润和病变体积。
结果
免疫组织化学分析显示，单纯减压硬脊膜切开组动物的瘢痕形成、空洞和炎症反应增加。与单纯挫伤组相比，行硬脊膜切开加硬脊膜同种异体移植的动物空洞和瘢痕形成减少。病变体积测量显示，单纯挫伤组（平均值和标准差，12.6 +/- 0.5 mm(3)) 和单纯硬脊膜切开组（15.1 +/- 1 mm(3)) 在 4 周时的空洞大小明显大于硬脊膜切开加硬脊膜同种异体移植组（6.8 +/- 1.4 mm(3))。
结论
与单纯减压相比，急性颈脊髓损伤后接受硬脊膜内空间减压和硬脊膜同种异体移植治疗的动物功能恢复更好。这些功能数据与脊髓空洞、炎症和瘢痕形成减少的组织学证据直接相关。
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