脊柱截骨术对家兔脊髓功能的影响

朱仲廉; 赵志; 王照东; 高许斌; 王旭义; 官建中

doi:10.16766/j.cnki.issn.1674-4152.002630

脊柱截骨术对家兔脊髓功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.002630

朱仲廉^{1, 2},
赵志^{1, 2},
王照东^{1, 2},
高许斌^{1, 2},
王旭义^{1, 2},
官建中^{1, 2, ,}

1.
蚌埠医学院第一附属医院骨科，安徽蚌埠 233004
2.
组织移植安徽省重点实验室，安徽蚌埠 233004

基金项目:

安徽省教育厅重点项目 SK2018A1077

蚌埠医学院自然科学重点项目 BYKY2019039ZD

蚌埠医学院自然科学基金面上项目 BYKY1776

详细信息

通讯作者:
官建中, E-mail: jzguan2002@163.com

中图分类号: R687.31
计量
- 文章访问数: 77
- HTML全文浏览量: 51
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2022-02-09
- 网络出版日期: 2022-11-29

Effects of vertebral osteotomy on spinal-cord function in rabbits

ZHU Zhong-lian^{1, 2},
ZHAO Zhi^{1, 2},
WANG Zhao-dong^{1, 2},
GAO Xu-bin^{1, 2},
WANG Xu-yi^{1, 2},
GUAN Jian-zhong^{1, 2
, ,}

1.
Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的研究脊椎截骨术对脊髓功能的影响，为脊椎截骨术的临床应用提供理论依据。方法将40只家兔以随机数字表法分为对照组、低截骨组(截骨后压缩25%)、中截骨组(截骨后压缩50%)、高截骨组(截骨后压缩100%)，每组10只，给予相应的手术处理。测定硬膜皱缩、运动功能(Reuter评分)、脊髓血流量等指标。结果中截骨组、高截骨组的硬膜囊横径、迂曲角为(5.74±0.29)mm、(14.46±0.77)°和(7.65±0.36)mm、(85.62±2.95)°，显著大于低截骨组[(4.85±0.32)mm、0°]和对照组[(4.39±0.11)mm、0°], 均P＜0.05。中截骨组、高截骨组的脊髓血流量为(27.66±0.85)μL/100 μm³、(10.53±0.24)μL/100 μm³，显著低于低截骨组[(34.28±0.94)μL/100 μm³]和对照组[(33.81±1.06) μL/100 μm³]，均P＜0.05。低截骨组、中截骨组、高截骨组的Reuters评分为(2.38±0.34)分、(7.25±0.42)分、(9.56±0.73)分，显著大于对照组的(1.39±0.25)分，均P＜0.05。结论脊椎截骨术具有较好的临床效果，较短的脊柱缩短对机体脊髓功能的影响小，临床实践中应注意把握安全截骨的临界值。
- 脊柱短缩术 /
- 脊髓功能 /
- 脊髓血流量
Abstract: Objective To explore the effect of vertebral osteotomy on the function of the spinal cord and to provide a theoretical basis for the clinical application of vertebral osteotomy. Methods By random-number table method, 40 rabbits were randomly divided into a control group, a low osteotomy group (compression 25% after osteotomy), a middle osteotomy group (compression 50% after osteotomy), and a high osteotomy group (compression 100% after osteotomy), with 10 animals each. They were given corresponding surgical treatment. Dural shrinkage, motor function (Reuter score), spinal-cord blood flow, and other indicators were determined. Results The dural sac transverse diameter and spinal cord of the middle and high osteotomy groups were (5.74±0.29) mm, (14.46±0.77)° and (7.65±0.36) mm, (85.62±2.95)°, which were higher than those of the low osteotomy[(4.85±0.32) mm, 0°] and control group [(4.39±0.11) mm, 0°], all P < 0.05. The blood flow of the middle and high osteotomy groups were (27.66±0.85) μL/100 μm³ and (10.53±0.24) μL/100 μm³, which were lower than those of the low osteotomy [(34.28±0.94) μL/100 μm³] and control group [(33.81±1.06) μL/100 μm³], all P < 0.05. The Reuter score of the low, middle, and high osteotomy groups [(2.38±0.34) points, (7.25±0.42) points, (9.56±0.73) points] were significantly higher than those of the control group[(1.39±0.25) points, all P < 0.05]. Conclusion Vertebral osteotomy has a good clinical effect. Shorter spine shortening has little effect on spinal-cord function. In clinical practice, attention should be paid to the critical value of safe osteotomy.
- Spinal shortening /
- Spinal cord function /
- Spinal-cord blood flow

HTML全文

表 1 各组家兔硬膜皱缩情况比较(x ±s)

Table 1. Comparison of dural shrinkage in rabbits in each group (x ±s)

组别	例数	硬膜囊横径(mm)	硬膜囊迂曲角(°)
对照组	10	4.39±0.11	0
低截骨组	10	4.85±0.32	0
中截骨组	10	5.74±0.29^a	14.46±0.77^a
高截骨组	10	7.65±0.36^a	85.62±2.95^a
F值		253.300	7 223.000
P值		< 0.001	< 0.001
注：与对照组比较，^aP＜0.05。

下载: 导出CSV

表 2 各组家兔Reuters评分比较(x ±s，分)

Table 2. Comparison of Reuters scores of rabbits in each group (x ±s, points)

组别	例数	术前Reuters评分	术后Reuters评分
对照组	10	0	1.39±0.25
低截骨组	10	0	2.38±0.34^a
中截骨组	10	0	7.25±0.42^a
高截骨组	10	0	9.56±0.73^a
F值			686.200
P值			< 0.001
注：与对照组比较，^aP＜0.05。

下载: 导出CSV

表 3 各组家兔脊髓血流量比较(x ±s，μL/100 μm³)

Table 3. Comparison of spinal cord blood flow of rabbits in each group (x ±s, μL/100 μm³)

组别	例数	脊髓血流量
对照组	10	33.81±1.06
低截骨组	10	34.28±0.94
中截骨组	10	27.66±0.85^a
高截骨组	10	10.53±0.24^a
F值		1 771.520
P值		< 0.001
注：与对照组比较，^aP＜0.05。

下载: 导出CSV

参考文献(18)

[1]	ZHAO Z, BI N, LI T, et al. Spinal-shortening process positively improves associated syringomyelia in patients with scoliosis after single-stage spinal correction[J]. World Neurosurg, 2021, 152: 161-167. DOI10.1016/j. wneu. 2021.05.073. doi: 10.1016/j.wneu.2021.05.073
[2]	ALDAVE G, HANSEN D, HWANG S W, et al. Spinal column shortening for tethered cord syndrome associated with myelomeningocele, lumbosacral lipoma, and lipomyelomeningocele in children and young adults[J]. J Neurosurg Pediatr, 2017, 19(6): 703-710. doi: 10.3171/2017.1.PEDS16533
[3]	阿尖措, 李占银. 后路全脊椎截骨术治疗重度僵硬性脊柱侧后凸畸形的安全性和有效性研究[J]. 山西医药杂志, 2021, 50(7): 1079-1081. A J C, doi: 10.3969/j.issn.0253-9926.2021.07.010 A J C, LI Z Y. Safety and efficacy of posterior total spinal osteotomy in the treatment of severe rigid kyphosis[J]. Shanxi Medical Journal, 2021, 50(7): 1079-1081. doi: 10.3969/j.issn.0253-9926.2021.07.010
[4]	经亚威, 徐继胜, 陈坤峰. 多节段非对称Ponte截骨治疗重度僵硬性特发性脊柱侧后凸的效果[J]. 河南医学研究, 2020, 29(22): 4089-4091. doi: 10.3969/j.issn.1004-437X.2020.22.022 JING Y W, XU J S, CHEN K F. Effect of multi-level asymmetric Ponte osteotomy in the treatment of severe rigid idiopathic kyphosis[J]. Henan Medical Research, 2020, 29(22): 4089-4091. doi: 10.3969/j.issn.1004-437X.2020.22.022
[5]	袁磊, 刘寅昊, 曾岩, 等. 后路全脊椎截骨矫形术治疗中重度胸腰椎角状后凸/侧后凸的中远期效果观察[J]. 中国脊柱脊髓杂志, 2020, 30(7): 596-603. doi: 10.3969/j.issn.1004-406X.2020.07.03 YUAN L, LIU Y H, ZENG Y, et al. Posterior vertebral column resection (PVCR) corrective surgery for moderate to severe focal kyphosis/kyphoscoliosis in the thoracolumbar spine[J]. Chinese Journal of Spine and Spinal Cord, 2020, 30(7): 596-603. doi: 10.3969/j.issn.1004-406X.2020.07.03
[6]	李昱, 张宏其, 王昱翔, 等. 后柱缩短钛网植骨治疗活动期胸腰段结核成角后凸[J]. 中国矫形外科杂志, 2020, 28(13): 1191-1194. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS202013009.htm LI Y, ZHANG H Q, WANG Y X, et al. Posterior column shortening and instrumented fusion with titanium mesh bone grafting for active thoracolumbar tuberculosis accompanied with angular kyphosis[J]. The Orthopedic Journal of China, 2020, 28(13): 1191-1194. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS202013009.htm
[7]	IDE K, HASEGAWA T, YAMATO Y, et al. Spinal shortening osteotomy for adult tethered cord syndrome evaluated by intraoperative ultrasonography[J]. J Orthop Sci, 2021, 26(3): 363-368. doi: 10.1016/j.jos.2020.05.003
[8]	谢江, 郭惠丽, 李辉, 等. 全脊椎截骨重建强直性脊柱后凸矢状面平衡的有限元分析[J]. 中国组织工程研究, 2021, 25(33): 5259-5264. doi: 10.12307/2021.311 XIE J, GUO H L, LI H, et al. Finite element analysis of reconstruction of sagittal balance in ankylosing kyphosis with vertebral column resection[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(33): 5259-5264. doi: 10.12307/2021.311
[9]	徐奎帅, 陈进利, 褚晏, 等. 开放楔形胫骨高位截骨术后并发症的危险因素分析与防治[J]. 中华全科医学, 2020, 18(12): 1986-1988, 2036. doi: 10.16766/j.cnki.issn.1674-4152.001669 XU K S, CHEN J L, ZHU Y, et al. Risk factors and prevention of complications after open wedge tibial high osteotomy[J]. Chinese Journal of General Practice, 2020, 18(12): 1986-1988, 2036. doi: 10.16766/j.cnki.issn.1674-4152.001669
[10]	REUTER D G, TACKER W A, BADYLAK S F, et al. Correlation of motor-evoked potential response to ischemic spinal cord damage[J]. J Thorac Cardiovasc Surg, 1992, 104(2): 262-272. doi: 10.1016/S0022-5223(19)34777-4
[11]	李辉, 张鹏, 尚俊, 等. 去松质骨截骨术与全脊柱截骨术治疗强直性脊柱炎后凸畸形有限元分析[J]. 山西医科大学学报, 2019, 50(3): 368-372. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYX201903024.htm LI H, ZHANG P, SHANG J, et al. Finite element analysis of vertebral column resection and vertebral column decancellation in treatment of ankylosing spondylitis kyphosis[J]. Journal of Shanxi Medical University, 2019, 50(3): 368-372. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYX201903024.htm
[12]	张力. 脊柱侧凸畸形行全脊椎截骨术后大量引流情况及危险因素分析[J]. 颈腰痛杂志, 2019, 40(2): 188-190. doi: 10.3969/j.issn.1005-7234.2019.02.014 ZHANG L. Situation and risk factors analysis of massive drainage after total vertebral osteotomy in the treatment of scoliosis deformity[J]. The Journal of Cervicodynia and Lumbodynia, 2019, 40(2): 188-190. doi: 10.3969/j.issn.1005-7234.2019.02.014
[13]	李庆, 蒋华, 曾勇, 等. 多模式神经电生理监测在严重脊柱畸形全脊椎截骨术中神经损伤的预警作用[J]. 颈腰痛杂志, 2019, 40(1): 70-72. doi: 10.3969/j.issn.1005-7234.2019.01.023 LI Q, JIANG H, ZENG Y, et al. Predictive value of severe intraoperative neurophysiological monitoring in patients with severe spinal deformity undergoing vertebral column resection[J]. The Journal of Cervicodynia and Lumbodynia, 2019, 40(1): 70-72. doi: 10.3969/j.issn.1005-7234.2019.01.023
[14]	路闯, 李辉, 祝文钢, 等. 后路选择性全脊椎截骨术治疗胸腰椎陈旧性骨折伴后凸畸形[J]. 中国矫形外科杂志, 2018, 26(17): 1627-1629. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS201817023.htm
[15]	赵阳阳, 谢雁春, 张昊聪, 等. 后路一期全脊椎截骨矫形治疗重度僵硬性胸腰椎侧后凸畸形的有效性及安全性分析[J]. 中国骨与关节杂志, 2018, 7(6): 417-422. https://www.cnki.com.cn/Article/CJFDTOTAL-GZGL201806006.htm LU C, LI H, ZHU W G, et al. Posterior selective total spinal osteotomy for the treatment of old thoracolumbar fractures with kyphosis[J]. The Orthopedic Journal of China, 2018, 26(17): 1627-1629. https://www.cnki.com.cn/Article/CJFDTOTAL-GZGL201806006.htm
[16]	ZHANG H Z, WANG B B, ZOU X B, et al. Relationship between the laminectomy extension and spinal cord injury caused by acute spinal shortening: Goat in vivo experiment[J]. Eur Spine J, 2020, 29(5): 1167-1174.
[17]	ZHAO Y Y, XIE Y C, ZHANG H C, et al. Effectiveness and safety of one stage posterior vertebral column resection in the treatment of severe rigid kyphoscoliosis[J]. Chinese Journal of Bone and Joint, 2018, 7(6): 417-422.
[18]	VALENTINI L G, VETRANO I G. Spinal column shortening for secondary TCS[J]. J Neurosurg Pediatr, 2022, 29(1): 124-125.