The Applied Anatomic Investigation Of The Pedicle Fat Grafts And Its Clinical Effects On Preventing Postoperative Epidural Scar Formation

ObjectiveTo observe the distribution of hypodermic capillary net of the dorsal branch of thethird lumbar segmental artery and to investigate its clinical effects on preventingpostoperative epidural scar formation following lumbar intervertebral disc herniationcombine with lateral recess stenosis surgery.Methods12sides of6adult cadavers were contributed to the investigation of the course anddistribution of lumbar segmental vessels and the distribution of hypodermic capillary net ofthe dorsal branch of the third lumbar segmental artery.According to the therapeuticmeathod，90patiens with lumber disc herniation combine with lateral recess stenosis whoperformed partial laminectomy and discectomy with nerves passage decompression weredivided into three groups: groupⅠ (31cases)，therapeutic group Ⅱ(29cases)，and normalcontrals(30cases).Group Ⅰtreated with fatty flap pedicled with the3rdlumbar vessels wasplaced at the sites of the laminectomy；GroupⅡ treated with2ml Chitsan was injectedaround epidural nerve root.90patients had A6-10years long-term follow-up (6years and9months in average).According to Oswestry disablibility index method， patientstherapeutic effect were evaluated after8weeks post-operation and more than6yearspost-operation．60cases were contributed to MR after more than6yearspost-operation．All dates were analyzed by SPSS13.0， the results of count data of eachgroup and the results of ranked data of each group using x2and rank sum test，the realationbetween MR classification and the results of long-term follow-up using the correlationanalysis and P values0.05as significant level. Results1. On the lateral face of the lumbar vertebral body，the third and the fourth segmentalarteries and veins accompaned with communicating branch remain constant while thefifth egmental artery and vein is quite variable. the third and the fourth segmental arteryand vein are presented constantly and run in the minor groove of the lumbar vertebral body.The dorsal branch of the third lumbar segmental artery penetrats the L3-L4intertransverseligament and the average diameter of the dorsal branch at the penetrating site is1.46±0.02mm.the lengths from the penetrating site to the lateral margin of sacrospinalmuscle are7.0±0.7cm in male and6.9±0.6cm in female. The dorsal branch of the thirdlumbar segmental artery forms hypodermic capillary net in the region.2,therapeutic effectin the eighth week showed No statistical differences among2theraputic groups but showedstatistical differences between therapeutic groups and normal controls.therapeutic effectafter long-term follow-up showed No statistical differences among theraputic groupⅡ andnormal controls， but showed statistical differences between therapeutic groupⅠ and oneof the other two groups.3,for60cases with MR grade and postoperative long-termfollow-up results, correlation analysis results show a very significant difference: the moreserious compression in spinal epidural, the worse effect in long-term follow-up results.Conclusion1,Findings of autopsy indicate that the pedicle fat grafts with the third lumbarsegmental artery is feasible to prevent postoperative epidural scar formation.2,patientsunderwent a unilateral partial laminectomy and discectomy with nerves passagedecompression in which Chitsan was used or fatty flap pedicled with the3rd lumbarvessels was used had a better short-term clinical curative effects，however，Concludedfrorm more than5years follow-up，The pedicle fat grafts can improve clinical effects ofpost-discectomy through reducing epidural scar formation and preventing peridural fibrosisand adhesion，the results further verify the results of clinical anatomy， which improve theresults of clinical anatomy， It is worthy of popularization and Application..