硬脊膜成形术通过减轻兔严重脊髓压迫性损伤后的椎管内压力和水肿促进功能恢复：实验研究
Duraplasty promotes functional recovery by alleviating intraspinal pressure and edema following severe spinal cord compression injury in rabbits: experimental studies.
作者信息
Yang Chaohua, He Tao, Ma Jingjin, Wang Qing, Wang Song, Wang Gaoju, Yang Jin, Chen Zhiyu, Li Qiaochu, Zhan Fangbiao, Jian Changchun, Feng Daxiong, Quan Zhengxue
机构信息
Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Jiangyang District, Sichuan 646000, China; Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China; Orthopedic Laboratory of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China.
Department of Orthopaedic Trauma, Chongqing General Hospital, Chongqing University, No.118 Xingguang Avenue, Liangjiang New District, Chongqing 401120, China.
出版信息
Spine J. 2025 Apr;25(4):805-819. doi: 10.1016/j.spinee.2024.12.007. Epub 2024 Dec 15.
BACKGROUND
After acute traumatic spinal cord injury (tSCI), various surgical strategies have been developed to alleviate elevated intraspinal pressure (ISP) and secondary injury.
PURPOSE
Our study aimed to investigate the impacts of duraplasty and laminectomy on edema progression, perfusion and functional outcomes after severe balloon compression SCI.
STUDY DESIGN
In vivo animal study.
METHODS
Closed balloon compression injuries were induced at the T7 level in rabbits using an inflated volume of 50 μl. Laminectomy (1-level laminectomy: 1-laminectomy; 3-level laminectomy: 3-laminectomy) and duraplasty were performed immediately after model generation. ISP was monitored using a SOPHYSA probe at the epicenter within 7 days post-SCI. Edema progression, perfusion and damage severity were evaluated by serial multisequence MRI scans, behavioral and bladder scores within 8 weeks post-SCI. Blood-spinal cord barrier (BSCB) permeability and histopathology were subsequently analyzed.
RESULTS
After SCI, ISP was steeply elevated in the control and 1-laminectomy groups, peaking at 33.14±4.91 and 31.71±4.50 mmHg at 48 h post-SCI; whereas in the 3-laminectomy and duraplasty groups, ISP peaked at 29.43±4.04 and 12.14±1.86 mmHg (p<.0001) at 72 h post-SCI. MRI and function scores showed that duraplasty significantly reduced the intramedullary lesion length (IMLL) and blood flow reduction ratio, and promoted fiber tract sparing and spinal cord functional recovery (p<.01). Histopathology revealed that duraplasty significantly reduced BSCB permeability, tissue loss and inflammation and promoted axon preservation (p<.01), while it did not increase early scar formation.
CONCLUSIONS
Duraplasty may alleviate secondary SCI and promote functional recovery. This neuroprotective mechanism may be related to reduced ISP and increased perfusion, resulting in reduced edema, BSCB permeability and inflammation and increased nerve fiber tract preservation.
CLINICAL SIGNIFICANCE
Duraplasty may promote functional recovery following severe tSCI patients, but further investigations are needed.
背景
急性创伤性脊髓损伤（tSCI）后，已开发出多种手术策略以减轻椎管内压力（ISP）升高和继发性损伤。
目的
我们的研究旨在探讨硬脊膜成形术和椎板切除术对严重球囊压迫性脊髓损伤后水肿进展、灌注及功能结局的影响。
研究设计
体内动物研究。
方法
使用50μl的充气量在兔的T7水平诱导闭合性球囊压迫损伤。模型建立后立即进行椎板切除术（单节段椎板切除术：1-椎板切除术；三节段椎板切除术：3-椎板切除术）和硬脊膜成形术。在脊髓损伤后7天内，使用SOPHYSA探头在损伤中心监测ISP。通过脊髓损伤后8周内的系列多序列MRI扫描、行为和膀胱评分评估水肿进展、灌注和损伤严重程度。随后分析血脊髓屏障（BSCB）通透性和组织病理学。
结果
脊髓损伤后，对照组和1-椎板切除术组的ISP急剧升高，在脊髓损伤后48小时分别达到峰值33.14±4.91和31.71±4.50 mmHg；而在3-椎板切除术组和硬脊膜成形术组中，ISP在脊髓损伤后72小时分别达到峰值29.43±4.04和12.14±1.86 mmHg（p<0.0001）。MRI和功能评分显示，硬脊膜成形术显著缩短了髓内病变长度（IMLL）和血流减少率，并促进了纤维束保留和脊髓功能恢复（p<0.01）。组织病理学显示，硬脊膜成形术显著降低了BSCB通透性、组织损失和炎症，并促进了轴突保留（p<0.01），同时并未增加早期瘢痕形成。
结论
硬脊膜成形术可能减轻继发性脊髓损伤并促进功能恢复。这种神经保护机制可能与降低ISP和增加灌注有关，从而减少水肿、BSCB通透性和炎症，并增加神经纤维束保留。
临床意义
硬脊膜成形术可能促进重度tSCI患者的功能恢复，但仍需进一步研究。
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