Department of Neurosurgery, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Neurozentrum, Breisacher Str. 64, D-79106, Freiburg, Germany.
Laboratory of Experimental Neurosurgery, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Neurozentrum, Breisacherstr. 64, Freiburg, Germany.
Acta Neurochir (Wien). 2020 Apr;162(4):737-743. doi: 10.1007/s00701-020-04254-4. Epub 2020 Feb 7.
Watertight closure of the dura mater is fundamental in neurosurgery. Besides the classical suturing techniques, a variety of biomaterials have been proposed as sealants. Platelet rich fibrin (PRF) is an autologous biomaterial which can readily be obtained through low-speed centrifugation of patient's own blood. It is rich in fibrin, growth factors, leucocytes and cytokines and has shown adhesive properties while promoting the physiological wound healing process. In this study, we investigated the effect of applying PRF in reinforcing the watertight dura mater closure.
We created an in vitro testing device, where the watertight dura mater closure could be hydrostatically assessed. On 26 fresh harvested bovine dura maters, a standardised 20-mm incision was closed with a running suture, and the leak pressure was measured first without (primary leak pressure) and then with PRF augmentation (secondary leak pressure). The two groups of measurements have been statistically analysed with the Student's paired t test.
The "running suture only group" had a leak pressure of 10.5 ± 1.2 cmH2O (mean ± SD) while the "PRF-augmented group" had a leak pressure of 47.2 ± 2.6 cm H2O. This difference was statistically significant (p < 0.001; paired t test).
Autologous platelet rich fibrin augmentation reliably reinforced watertight closure of the dura mater to a > 4-fold increased leak pressure after failure of the initial standard running suture technique.
硬脑膜的严密缝合是神经外科的基础。除了经典的缝合技术外，还提出了多种生物材料作为密封剂。富含血小板的纤维蛋白 (PRF) 是一种自体生物材料，可以通过低速离心患者自身的血液轻松获得。它富含纤维蛋白、生长因子、白细胞和细胞因子，具有粘附特性，同时促进生理伤口愈合过程。在这项研究中，我们研究了应用 PRF 增强硬脑膜严密缝合的效果。
我们创建了一个体外测试装置，可以对硬脑膜的严密缝合进行液压评估。在 26 块新鲜采集的牛硬脑膜上，用连续缝合线闭合一个标准化的 20-mm 切口，并首先测量没有（初次泄漏压力）然后用 PRF 增强（二次泄漏压力）时的泄漏压力。使用学生配对 t 检验对两组测量值进行了统计学分析。
“仅缝线组”的泄漏压力为 10.5±1.2 cmH2O（平均值±标准差），而“PRF 增强组”的泄漏压力为 47.2±2.6 cm H2O。差异具有统计学意义（p<0.001；配对 t 检验）。
自体富含血小板的纤维蛋白增强剂可靠地增强了硬脑膜的严密缝合，在初始标准连续缝合技术失败后，泄漏压力增加了>4 倍。
