中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (30): 4483-4488.doi: 10.3969/j.issn.2095-4344.2016.30.011

• 药物控释材料 drug delivery materials • 上一篇    下一篇

浸润醋酸泼尼松龙的明胶海绵可改善后路腰椎间融合后根性症状

姚珍松，陈 康，江晓兵，梁 德，唐晶晶   

  1. 广州中医药大学第一附属医院脊柱骨科，广东省广州市 510405
  • 出版日期:2016-07-15 发布日期:2016-07-15
  • 通讯作者: 梁德，主任医师，教授，博士生导师，广州中医药大学第一附属医院脊柱骨科，广东省广州市 510405
  • 作者简介:姚珍松，男，1971年生，贵州省遵义市人，汉族，2007年广州中医药大学毕业，博士，副主任医师，主要从事脊柱退变及创伤相关疾病的研究。
  • 基金资助:

    卫生部医药卫生科技发展研究中心资助课题(W2014ZT256)；卫生部医药卫生科技发展研究中心资助课题(W2012ZT07)；广东省卫生厅医学科研基金(2014B2014175)

Gelatin sponge containing prednisolone acetate relieves radicular pain following posterior lumbar interbody fusion

Yao Zhen-song, Chen Kang, Jiang Xiao-bing, Liang De, Tang Jing-jing   

  1. Department of Spinal Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Online:2016-07-15 Published:2016-07-15
  • Contact: Liang De, Chief physician, Professor, Doctoral supervisor, Department of Spinal Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Yao Zhen-song, M.D., Associate chief physician, Department of Spinal Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:

    the Pharmaceutical Technology Development Research Center of Health Ministry Funded Project, No. W2014ZT256, W2012ZT07; the Medical Research Foundation of Guangdong Provincial Health Department, No. 2014B2014175

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摘要：

文章快速阅读：

文题释义：
醋酸泼尼松龙-明胶海绵：在减压神经根周围置入醋酸泼尼松龙浸润的明胶海绵，有助于通过术区局部控释醋酸泼尼松龙控制炎症反应降低减压后神经根性痛的复发率，同时可通过明胶海绵的缓慢降解控制相关炎症及生长因子的分泌，达到减轻血肿形成及组织增生粘连的目的，有助于减少术后局部瘢痕粘连及瘢痕长入椎管，对提高术后患者舒适度，促进术后患者身心康复大有裨益。
后路腰椎间融合优势：对中央管减压彻底，对于治疗下腰段偏中央型椎间盘突出合并椎间不稳者具有独特的技术优势，尽管术中常需对硬膜囊和神经根进行牵拉，容易诱发神经根炎性水肿而出现术后早期的下肢神经根性疼痛症状，但对其适应证的患者减压效果仍然值得肯定。

 

背景：后路腰椎间融合对中央管减压彻底，对于下腰段偏中央型椎间盘突出合并椎间不稳的患者是常用的治疗方法，但其术中常需对硬膜囊和神经根进行牵拉，容易诱发术后早期的下肢根性痛。
目的：观察神经根周围覆盖含醋酸泼尼松龙的明胶海绵对后路腰椎椎体间融合后根性症状的改善作用。
方法：将63例单侧腰椎间盘突出症合并相应节段不稳患者，按植入物类型分为治疗组(n=21)和对照组(n=42)，其中治疗组患者采取后路腰椎间融合后置入浸润醋酸泼尼松龙注射液的明胶海绵，对照组患者仅单纯置入明胶海绵。
结果与结论：①与对照组相比，治疗组患者治疗后1周内下肢疼痛缓解明显，而6个月时2组目测类比评分和Oswestry功能障碍指数接近；②对照组术后有3例患者下肢痛复发，2组患者均未出现切口感染、硬膜外血肿等并发症；③提示后路腰椎间融合结合神经根周围覆盖醋酸泼尼松龙明胶海绵可有效改善腰椎间盘突出症患者术后早期的下肢根性疼痛，有利于早期进行康复锻炼，提升患者术后近期满意率。

ORCID: 0000-0003-4989-532X(梁德)

关键词: 生物材料, 骨生物材料, 腰椎退行性变, 腰椎间盘突出症, 腰椎不稳, 后路腰椎间融合, 醋酸泼尼松龙, 明胶海绵, 神经根性疼痛, 术后康复

Abstract:

BACKGROUND: Posterior lumbar interbody fusion can thoroughly decompress the central canal, which is the common surgical technique for the central type of lumbar disc herniation with intervertebral instability at low lumbar segment. However, due to the regular traction on dural sac and nerve root in the operation, lower limb radicular pain in the early stage is inevitable.
OBJECTIVE: To evaluate the effect of local use of gelatin sponge containing prednisolone acetate around the nerve roots after posterior lumbar interbody fusion on lower limb radicular pain.
METHED: Sixty-three cases of lumbar disc herniation with degenerative instability were devided into treatment group (n=21) and control group (n=42) based on the type of implants. Gelatin sponge containing prednisolone acetate was implanted into patients in the treatment group after posterior lumbar interbody fusion, while pure gelatin sponge was implanted into patients in the control group.
RESULTS AND CONCLUSION: Compared with the control group, radicular pain in the treatment group was significantly relieved within 1 week after surgery. The visual analog scale score and Oswestry disability index score were similar between the two groups. There were three cases of radicular pain recurrence in the control group, but no incision infection and epidural hematoma after surgery in both two groups. In conclusion, local use of gelatin sponge containing prednisolone acetate around the nerve roots can significantly relieve lower limb radicular pain in the early stage after posterior lumbar interbody fusion in lumbar disc herniation, contributing to early rehabilitation exercise and patient satisfaction outcomes.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

Key words: Prednisolone, Intervertebral Disk Displacement, Spinal Fusion, Tissue Engineering

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