Park Y K, Tator C H
Division of Neurosurgery, Toronto Hospital and University of Toronto, Ontario.
Neurosurgery. 1998 Apr;42(4):813-23; discussion 823-4. doi: 10.1097/00006123-199804000-00076.
Arachnoidal adhesions and inflammation were evaluated in 72 rats after spinal dural repair with one of three materials, i.e., Gore-Tex surgical membrane, collagen-coated Vicryl mesh, or lyophilized spinal dural allograft.
Laminectomy at L1 was performed, and then a 3- x 4-mm segment of spinal dura mater and arachnoid membrane was excised. After implantation of the dural substitute, the animals were divided into normal and injured groups. In the injured group, a spinal cord injury was produced at the midpoint of the duraplasty site by the clip compression technique, with 25-g force for 1 minute. Neurological performance was assessed by the inclined plane technique, and groups of rats were killed at 8 to 24 weeks after surgery. The spinal column was removed en bloc and processed for histological examination.
There were no differences in neurological function among the three dural substitutes in either injured or noninjured rats. However, there were major differences among the groups in the incidence and severity of arachnoid adhesions and tethering. The neural tissue was bound to a thick neomembrane surrounding the lyophilized dural allograft and the collagen-coated Vicryl mesh. In contrast, the Gore-Tex surgical membrane induced only a thin membranous adhesion, which was loose and flexible. The inflammatory and foreign body response was most pronounced in rats treated with collagen-coated Vicryl mesh, at 8 and 24 weeks.
In the present study, Gore-Tex surgical membrane was a very good material for the surgical repair of spinal dural defects. Additional experimental studies are required to compare Gore-Tex membrane with autologous tissues.
在72只大鼠进行脊髓硬膜修复后，使用三种材料之一（即戈尔特斯外科膜、胶原涂层薇乔网或冻干脊髓硬膜同种异体移植物）评估蛛网膜粘连和炎症情况。
在L1节段进行椎板切除术，然后切除3×4毫米的脊髓硬膜和蛛网膜节段。植入硬膜替代物后，将动物分为正常组和损伤组。在损伤组中，通过夹子压迫技术在硬脑膜成形术部位的中点造成脊髓损伤，施加25克力，持续1分钟。通过斜面技术评估神经功能，在手术后8至24周处死大鼠组。将脊柱整块取出并进行组织学检查。
在受伤或未受伤的大鼠中，三种硬膜替代物在神经功能方面没有差异。然而，在蛛网膜粘连和束缚的发生率和严重程度方面，各组之间存在重大差异。神经组织与围绕冻干硬膜同种异体移植物和胶原涂层薇乔网的厚新膜相连。相比之下，戈尔特斯外科膜仅引起薄的膜性粘连，这种粘连疏松且灵活。在8周和24周时，胶原涂层薇乔网治疗的大鼠炎症和异物反应最为明显。
在本研究中，戈尔特斯外科膜是脊髓硬膜缺损手术修复的一种非常好的材料。需要进行更多的实验研究来比较戈尔特斯膜与自体组织。
