Patin D J, Eckstein E C, Harum K, Pallares V S
Department of Anesthesiology, University of Miami/Jackson Memorial Medical Center, Florida.
Anesth Analg. 1993 Mar;76(3):535-40. doi: 10.1213/00000539-199303000-00014.
Determinants of dural defects subsequent to deliberate or accidental dural puncture include the equipment, techniques, and the inherent anatomic and biomechanical properties of dura mater. These properties were studied in specimens of human and canine lumbar dura mater in an attempt to delineate the structure of the tissue and to characterize its behavior in biomechanical terms. Human dura had a longitudinal orientation on gross appearance, and was confirmed microscopically to be composed of longitudinal lamella of collagen and elastin fibers. Longitudinal tensile strength and stiffness were greater than transverse tensile strength and stiffness, which is consistent with the dura's apparent anatomic structure and functional requirements. Additional biomechanical testing of the dura demonstrated the property of relaxation which is a characteristic of a viscoelastic material. Significant differences were observed between human and canine dural properties, suggesting limited value of this animal model. Integration of these observed anatomic and biomechanical properties of the lumbar dura provides a greater understanding of dural puncture and may explain previous and often confusing clinical and experimental findings.
有意或意外硬脊膜穿刺后硬脊膜缺损的决定因素包括设备、技术以及硬脊膜固有的解剖学和生物力学特性。对人类和犬类腰椎硬脊膜标本进行了这些特性的研究,旨在描绘该组织的结构并从生物力学角度描述其行为。肉眼观察时,人类硬脊膜呈现纵向走向,显微镜检查证实其由纵向排列的胶原纤维和弹性纤维薄片组成。纵向拉伸强度和刚度大于横向拉伸强度和刚度,这与硬脊膜明显的解剖结构和功能需求一致。对硬脊膜进行的额外生物力学测试表明其具有松弛特性,这是粘弹性材料的一个特征。观察到人类和犬类硬脊膜特性存在显著差异,表明该动物模型的价值有限。整合所观察到的腰椎硬脊膜的这些解剖学和生物力学特性,能更深入地理解硬脊膜穿刺,并可能解释既往常常令人困惑的临床和实验结果。