Dexamethasone-soaked gelatin sponges prevent epidural adhesion

doi:10.3969/j.issn.2095-4344.2015.08.004

Abstract

Abstract:

BACKGROUND: Clinically, dexamethasone-soaked gelatin sponges that are placed around the nerve root and spinal dura mater in lumbar disc excision have achieved good results.

OBJECTIVE: To understand the effect of dexamethasone-soaked gelatin sponges in prevention of epidural adhesion in animals.

METHODS: Forty New Zealand white rabbits were randomly divided into four groups followed by removal of L₄, L₇ laminae, and a 1.0 cm×0.5 cm lamina dura area was exposed in each group. Then, the dura and nerve root were covered with dexamethasone-soaked gelatin sponges, dexamethasone, gelatin sponge and nothing (blank group), respectively. At 2, 4, 6, 8, 12 weeks after surgery, the entire operated vertebral segment and its accessories and paraspinal muscles were taken for gross and microscopic observation of nerve root and dural tissue adhesions.

RESULTS AND CONCLUSION: At 12 weeks postoperatively, new bone tissue formed generally at the site of laminectomy defect in the dexamethasone-soaked gelatin sponge group, with separable yellow-white membranous tissue around the dura; histological results showed the complete structure of fat cells, clearly distinct from the dura; there was no scar cell formation, no adhesions, no trabecular bone cartilage cells and hyperplasia. In the other three groups, a large number of peripheral epidural scar tissues were generally seen, epidural adhesions were serious that could not be separated bluntly, and histological results showed collagenization of granulation tissue, dural thickening and serious adhesions. The findings indicate that dexamethasone-soaked gelatin sponges can synergistically prevent epidural adhesions.

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

全文链接：

Key words: Dexamethasone, Gelatin Sponge, Absorbable, Anesthesia, Epidural

CLC Number:

R318

Fang Huai-xi, Zhang Ming, Yue Guo-ping . Dexamethasone-soaked gelatin sponges prevent epidural adhesion [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(8): 1165-1169.

Figures/Tables 4

2.1 实验动物数量分析 40只新西兰大白兔均完成手术操作，其中死亡2只，分别为地塞米松组第10天死亡1只和明胶海绵组第22天死亡1只，未对本实验结果造成影响。 2.2 大体观察地塞米松明胶海绵组：术后2周时可见椎板缺损处少量的肉芽组织，质地软，明胶海绵很好地覆盖缺损处，与硬膜囊间间隙存在，易分离；4周时明胶海绵基本吸收，背侧可见少量瘢痕，腹侧与硬脊膜无粘连；6周时未见明胶海绵，椎板缺损处较4周缩小，背侧可见少量增生组织，质软，苍白，与硬脊膜有膜性粘连，但易分离；8，12周可见椎板缺损处有新生骨形成，硬脊膜周围有黄白色膜性组织，可分离。地塞米松组：术后2周时可见少量肉芽组织填充，局部少量炎症增生，与硬脊膜存有间隙，无粘连；4-6周肉芽组织逐渐增多，质软，部分与硬脊膜片状粘连，尚可分离；8-12周椎板缺损两侧可见瘢痕组织逐渐增多，覆盖硬脊膜，质地硬，剥离困难，粘连逐渐加重。明胶海绵组：术后2周明胶海绵部分吸收，背侧可见炎性组织增生，腹侧与硬脊膜有间隙，内有血性机化组织填充，与硬脊膜无粘连；4周时可见部分明胶海绵，与硬脊膜有黄白色膜性粘连，质地稍软，尚可分离；与4周相比，6-8周时明胶海绵完全吸收，硬脊膜外围有大量瘢痕组织，质地硬，粘连逐渐加重，难分离；12周时明胶海绵成分消失，大量胶原纤维瘢痕组织取代，与硬脊膜粘连严重，无法钝性分离，分离后硬脊膜破裂。空白组：椎板缺损处瘢痕的范围和量随时间的延长呈增长趋势，质地逐渐致密，瘢痕与硬脊膜粘连越来越严重，术后12周时严重无法分离，分离后硬脊膜破损。此组较地塞米松、明胶海绵组粘连严重。各组粘连分级情况见表1。由表2可见，术后2周按照多个样本比较的秩和检验，得4组之间无差异(P=0.110 6)，术后4，6，8，12周按照样本间两两比较的秩和检验，组间比较地塞米松明胶海绵组与地塞米松组、明胶海绵、空白组间差异有显著性意义(P < 0.05)，而后3组间差异无显著性意义(P > 0.05)。 2.3 组织学观察见图1。地塞米松明胶海绵组：术后2周可见明胶海绵成分、成骨细胞及造血细胞，硬脊膜周围少量脂肪细胞且细胞结构完整；4周时硬脊膜外脂肪细胞分布均匀，与明胶海绵成分存在间隙，其内少量炎性细胞填充；6周时未见明胶海绵成分，炎性细胞明显减少，毛细血管增生，成纤维细胞侵入，与硬膜囊无明显粘连；8时周成骨细胞增生活跃，部分形成骨小梁，炎性细胞消失；12周时脂肪细胞结构完整，与硬脊膜之间分界明显，无瘢痕细胞形成，无粘连，软骨细胞及骨小梁增生。地塞米松组：术后2周可见少量成骨细胞及造血细胞，未见炎性细胞；4周见软骨细胞、成纤维细胞及中性炎性细胞少量增生，部分与硬脊膜粘连；6周时见毛细血管少量增生，成纤维细胞增生活跃，未见脂肪细胞，硬脊膜外间隙减少向腹侧受压；8周时成纤维细胞转化纤维母细胞，脂肪细胞泡状融合；12周时肉芽组织均转化为胶原纤维，硬脊膜与瘢痕粘连严重。明胶海绵组：术后2周可见明胶海绵成分，硬脊膜间隙内可见大量炎性细胞以中性细胞为主以及不同时期的造血细胞，大量梭形成纤维细胞增生；4周时明胶海绵部分吸收，可见炎性细胞浸润，纤维细胞、毛细血管少量增生活跃，与硬脊膜呈点状疏松粘连；6周时成纤维细胞转化纤维母细胞，肉芽组织增多并与残存明胶海绵成分结合，粘连致密；8-12周时炎性细胞逐渐减少，肉芽组织胶原化，硬脊膜增厚，粘连严重。空白组：术后2周可见中性炎性细胞浸润，毛细血管增生，梭形成纤维细胞增生活跃；4周时出现大量炎性细胞，成纤维细胞、毛细血管少量增生，硬脊膜外间隙缩小，尚未压迫硬膜囊；6-8周时脂肪细胞泡状融合，成纤维细胞逐渐转化为纤维母细胞，炎性细胞减少并纤维化，胶原致密，粘连加重；12周时瘢痕面积较少，粘连较8周严重。按光学显微镜观察标准各组粘连分级见表3。术后2，4周按照多个样本比较的秩和检验，得4组之间无差异(P=0.408 8，0.068 2)；术后6，8，12周按照样本间两两比较的秩和检验，组间比较地塞米松明胶海绵与地塞米松组、明胶海绵组、空白组间差异有显著性意义(P < 0.05)，而后3组间差异无显著性意义，见表4。"

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