【摘要】 背景:同种异体冻干辐照骨是一种较理想的骨缺损填充修复生物材料,是否可应用于预防椎板切除术后硬膜粘连。目的:观察同种异体骨板覆盖预防椎板切除术后硬膜外粘连再狭窄的作用。设计:病例随访调查。单位:华中科技大学同济医学院附属协和医院骨科;中国辐射防护研究院山西省医用组织库。对象:选择2003-03/2005-06于华中科技大学同济医学院附属协和医院骨科收治的58例节段性腰椎管狭窄患者,男34例,女24例,年龄30～78岁。单纯腰椎管狭窄25例,合并腰椎间盘突出33例L4～536例,L5,S122例,所有患者年龄,性别,健康情况等无统计学差异。方法:对58例腰椎间盘突出或腰椎管狭窄患者行节段性全椎板切除,“H”形同种异体冻干辐照骨板覆盖。按照中华骨科学会腰椎手术疗效随访标准评价患者术后临床症状改善情况,并观察植入骨板吸收状况及CT、MRI表现。主要观察指标:所有患者术后临床症状改善情况;腰椎管CT及MRI观察骨板吸收情况。结果:纳入58例患者全部进入结果分析。术后半年随访21例,按照中华骨科学会腰椎手术疗效随访标准,其中优17例,良4例。术后1年随访23例,CT、MRI显示椎管明显扩大,骨板无倾斜、移位,脊髓无压迫;术后1.5年随访14例,CT显示椎管内容物形态良好,骨板两侧已与相邻接触骨组织融合,密度相等,无排异反应。结论:同种异体冻干辐照骨板是一种良好的硬膜外覆盖材料,术后1.5年病例影象学提示未发生硬膜外粘连,防止了椎管术后的再狭窄,可用于节段性椎板覆盖成型术。更多还原

【Abstract】 BACKGROUND: To discuss the feasibility of allogeneic freeze-drying radiation sterilization bone sheet applying in the prevention of post-laminectomy adhesion as an ideal biological material for filling and repairing bone defect. OBJECTIVE: To observe the preventive effect of allogeneic freeze-drying radiation sterilization bone sheet on the postlaminectomy adhesion and restenosis. DESIGN: Follow-up survey on cases. SETTINGS: Department of Orthopedics,Union Hospital,Tongji Medical School of Huazhong University of Science and Technology; Shanxi Medical Tissues of China Institute for Radiation Protection PARTICIPANTS: From March 2003 to June 2005,58 patients with segmental lumbar spinal stenosis (LSS) were selected from Department of Orthopedics,Union Hospital,Tongji Medical School of Huazhong University of Science and Technology,including 34 males and 24 females,aged 30-78 years,including 25 cases of simple LSS and 33 combined LSS; and including 36 cases in L4-5 and 33 cases in L5,S1 segments. All the patients were similar in age,gender and healthy conditions. METHODS: The segmental whole laminectomies were performed in 58 patients with prolapse of lumbar intervertebral or LSS,and allogeneic freeze-drying radiation sterilization bone sheet in "H" shape was used to cover the vertebral laminae. According to the follow-up standard of lumbar spine operation recommended by the Orthopaedics Branch of Chinese Medical Association,all patients were followed up to evaluate their clinical symptoms,absorption of implanted bone as well as CT and MRI presentations. MAIN OUTCOME MEASURES: Improvements of clinical symptoms; Absorption of bone sheet in lumbar spinal canal. RESULTS: Totally 58 LSS patients were involved in the result analysis. In postoperative 0.5-year follow-up period,17 of 21 patients showed excellent curative effects while other 4 patients showed fine effects. In postoperative 1-year follow-up period for 23 patients,CT and MRI results demonstrated that the spinal canal had been extended obviously. There was no tilt or displacement of the femoral sheet or compression of the spinal cord. As for 14 patients who were followed up for 1.5 years,CT results displayed that there was no rejective reaction observed in this study. The edge of the allograft was inosculated with connective lamina of vertebra,and the shape of lumber spinal was good. CONCLUSION: Allogeneic freeze-drying radiation sterilization bone sheet is an ideal dressing material for epidural laminoplasty. The imaging results of patients in postoperative 1.5-year follow-up indicate that it can effectively reduce the post-laminectomy adhesion formation and prevent recurrence of post-laminectomy spinal restenosis,so as to apply on the segmental vertebral plate dressing.更多还原