An Experimental Study On Preventing Adhesion Of Peridural With Variable Material After Laminectomy

Background and Objective: Laninotomy and discectomy are very popular in the spine surgery ,and the fibrosis and scar formation post peration of laminotomy may arouse the extensive adhesion around peridural and nerve root . Untoward scar formation is often a contributing failure back surgery sydrom (FBSS).Burton et.al report that only 48%patient were satisfied with the secondary operation after FBSS.To prevent the postoperative adhesion ,improve the ratio of cure and reduce the ratio of recrudesce are of importance to the curative effect of low back surgery.Great efforts have been taken in the world wide among many scholars.The outcome is vary with most of them are inplant single medicine or intermediate.In this thesis research on preventing adhesion of peridural with single or a pair of material combined have been carried out through animal experiments and clinical applicantions.Material and Methods :42 New Zealand rabbits were used as the animal model in this study.Laminectomy was preformed in lumbar 2 segment ,lumbar 5 segment of every rabbit respectively through two isolate incisions .10mm X 5mm dura mater was exposed in each lumbar segment .The group A was sutured directly ,which was regard as control group.;covered with suitable gelatin sponge in group B;with solution of quanade stored gelatin sponge dura mater in group C;droped 0.1ml solution of diprospan dipping the dura mate in group D;covered with 2% sodium hyaluronate gelation as the thick of 2mm film in groupE;with diprospan and sodium hyalunonate gelation match and mixed completely covered in group F.The animal were sacrificed at 4 .8. 12 weeks postoperatively.The specimens were prepared for macroscopy .light microscopy .electron microscopy and computer image analysis .Results At 12 week .macroscopy and light microscopy showed that in A ,B and C groups peridural scar were dense and wide spread and adhered to dura tightly; less and sparse formed in group D and E ;no obvious adhesion formed in group F.According to the Rydell and improved Nussbaum Criterion and thecomputer image analysis result .statistically there was a significant difference between ABC -group and DEF group ;between D or E group respectively and F group. Electron microscopy showed that in control group the epidural tissue was mainly dense scar and in group D E and group F it was mainly fat tissue which mixed with a few of collagen fibers. Conclusion :The combination of diprospan and sodium hyalunonate gelation showed the positive joint effect ;which can prevent the adhesion after laminectomy effectively;the single application of diprospan or hyalunonate gelation can reduce the adhesion but less than that of the combination. Furthermore the later enhanced the risky of infect .the gelatin sponge enrich the adhesion and have no associate effect with which combine quanande.