黄芪桂枝五物汤预防椎板切除后硬膜外瘢痕粘连实验研究
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
目的:观察和评价内服黄芪桂枝五物汤对椎板切除模型动物硬膜外瘢痕粘连的干预作用效果,并探讨其作用机制。方法:36只成年雄性SD大鼠随机分为三组:A生理盐水组为实验条件对照组、B双氯芬酸钠组为阳性对照组和C黄芪桂枝五物汤组为实验组,行L1椎板切除术,造成0.3cm×0.8cm大小缺损,术后A组、B组和C组分别连续灌服生理盐水、双氯芬酸钠混悬液和黄芪桂枝五物汤4周后停药。分别于术后第4周和第8周分两批处死动物,每组每批随机抽取5只取术段脊椎进行大体观察评估瘢痕粘连韧度、HE染色光学切片组织学观察及测定瘢痕组织中羟脯氨酸(HOP)含量。结果:术后4周,A组大体及组织学观察结果评分差于B组和C组,有统计学意义(P<0.05),A组和B组羟脯氨酸含量高于C组,有统计学意义(P<0.05)。术后8周,A组和B组大体观察、组织学观察结果和羟脯氨酸含量与C组比较均有统计学意义(P<0.05),A组、B组和C组三组间羟脯氨酸含量比较均有统计学意义(P<0.05)。结论:黄芪桂枝五物汤可以减少大鼠椎板切除后硬膜外瘢痕组织中胶原含量,阻止硬膜外瘢痕粘连形成。其有效性可能是通过加速局部血肿及炎性物质的清除,抑制炎性细胞、成纤维细胞的增殖和增加椎板切除区椎体的稳定性等作用来实现。黄芪桂枝五物汤早期有预防大鼠椎板切除后硬膜外瘢痕粘连的作用。
Objective:To study the effectiveness of Huangqi Guizhi Wuwu Decoction on preventing post-laminectomy fibrosis and adhesion. Methods:36 adult rats were divided randomly into three groups: Group Nacl (Group A), Group Diclofenac Sodium Enteric-coated Tablets (Group B), and Group Huangqi Guizhi Wuwu Decoction (Group C). All the rats were established as the experimental models undergoing L1 laminectomy with 0.3cm×0.8cm dura mater exposed. All laminectomy levels were treated with relative medicine for four weeks: At the 4th and 8th weeks after laminectomy, the samples were obtained for gross observation, histological examinations and to detecting the contents of hydroxyprdine. Results: At the 4th week, the gross observation and histological examinations in Group A were significantly higher than those in Group B and Group C(P<0.05), the contents of hydroxyprdine of Group A and Group B were significantly different than those of Group C(P<0.05). At the 8th week, all the indexes of Group A and Group B were significantly higher than those of Group C(P<0.05), the contents of hydroxyprdine of Group A , Group B and Group C were significantly different (P<0.05). Conclusions:The drugs of Huangqi Guizhi Wuwu Decoction could reduce scar formation, loosen fibroscar and inhibit the formation of adhesion in rats.
引文
[1]王欢,郝立波,王海义.血肿在硬膜外瘢痕粘连作用的探讨[J].中华骨科杂志. 1998, 18(3): 61.
    [2] Edward Covington, Paul Dreyfuss, Conor O’Neil. Failed back surgery: etiology and diagnostic evaluation[J]. The Spine Journal. 2003, 3: 400-403.
    [3] Braverman DL, Slipman CW, Lenrow DA. Using gabapentin to treat failed back surgery syndrome caused by epidural fibrosis: A report of cases[J]. Arch Phys Med Rehabil. 2001, 82(5): 691-693.
    [4] Isla , Alvarez F. Spinal epidural fibrosis following lumbar diskectomy and antiadhesion barrier[J]. Neuroeirugia(Astur). 2001, 12(5): 439-446.
    [5]张丙磊,王道谦.防止椎板切除术后硬脊膜外瘢痕粘连的实验研究[J].中华骨科杂志. 1997, 17(2): 137-139.
    [6] Hinton JL, W DJ, MeiY, et al. Inhibition of epidural scar formation after lumbar laminectomy in the rat[J]. Spine. 1995, 20: 564-570.
    [7] Gerszten PC, Mossy, Flocking JC, et al. Inhibition of epidurals fibrosis after laminectomy using low-dose external beam radiation in dog model[J]. Neurosurgery. 2000, 46 (6): 1478-1485.
    [8] Lawson KJ, Malycky JL, Berry JL, et al. Lamina repair and replacement to control laminectomy membrane formation in dogs[J]. Spine. 1991, 16: 222.
    [9] Nussbaum CE, Medonald JV, Baggs RB. Use of vicryl mesh to limit epidural scar formation after laminectomy. Neurosurgery. 1990, 26: 649.
    [10]黎鳌主编.现代创伤学[M].北京:人民卫生出版社. 1997, 152.
    [11] Jensen TT, Asmussen K, Betg-Hansen EM, et al. First-time operation for lubmar disc herniation with or without free fat transplantation. Prospectice triple-blind randomized study with reference to clinical factors and enhanced computed tomographic scan 1 year after operation[J]. Spine. 1996, 21(29): 1072-1076.
    [12]中勇,程志山,郭斌.几丁糖改性膜预防椎板切除术后硬膜外粘连[J].临床骨科杂志. 2004, 7(1): 100-104.
    [13]张仲文,徐莘香,杨传铎,等.聚己内酯/聚乳酸膜防止硬膜外瘢痕粘连的实验研究[J].中华外科杂志. 2004, 42(24): 1497-1500.
    [14]刘立岷,宋跃明,段宏,等.聚乳酸凝胶预防硬膜外瘢痕粘连的实验研究[J].中国修复重建外科杂志. 2005, 19(1): 48-51.
    [15]李波,丁一,罗春山,等.几丁糖-钛网联合运用防治椎板切除后瘢痕粘连的实验研究与临床应用初探[J].贵州医药. 2007, 3l(4): 142-145.
    [16]吴震东,于晓华.腰椎间盘术中游离脂肪移植的意义研究[J].颈腰痛杂志. 1998, 19(2): 157.
    [17]王宸,钱卫庆,陈昌红.透明质酸钠复合纤维蛋白凝胶预防硬膜外粘连的实验研究[J].现代医学. 2007, 35(2): 101-104.
    [18]郑淑慧,石奉文,韩庆华.椎板切除术后瘢痕生成及硬膜外粘连之预防的研究进展[J].中国脊柱脊髓杂志. 1995, 5(1): 40.
    [19] Masato Nakano, Hisao Matsui, Kentaro Miaki, et al. Post-laminectomy adhesion of the Cauda Equina inhibitory effects of anti-inflammatory drugs on Cauda Equina adhesion in rats. Spine[J]. 1998, 23(3): 298-304.
    [20] He Y, Revel M, Loty B. A quantitative model of post-laminectomy scar formation: Effects of a nonsteroidal anti-inflammatory drug[J]. Spine, 1995, 20(5): 557.
    [21]杨茂伟,胡宝山.塞来昔布预防椎板切除术后硬脊膜外粘连的研究[J].中国现代医学杂志. 2003, 13(l6): l2-l4.
    [22]韩元龙,姜江.髓核摘除术后配合补阳还五汤治疗腰椎间盘突出症[J].中国中医骨伤科. 1995, 3(4): 33.
    [23]周辉,郑悦亮.活血止痛汤对兔硬膜外瘢痕中TGF-B1表达的影响[J].中国中医骨伤科杂志. 2005, 13(2): 7-9.
    [24]周斌,王荣茂,廖增年.活血消瘢冲剂预防腰椎间盘突出术后硕膜外瘢痕的临床研究[J].中国骨伤. 2004, l7(9): 513-516.
    [25]高峰,王亚斌.腰椎间盘突出症术后并发症的中药预防[J].中国骨伤. l997, (6): 49.
    [26]沈权,侯筱魁,叶澄宇,等.黄芪预防术后硬膜外粘连的实验研究[J].中国骨伤. 2001, 14(3): 152-153.
    [27]李智军,魏连波,贺丰,等.黄芪多糖治疗大鼠系膜细胞增生性肾炎的实验研究[J].中国中西医结合肾病杂志. 2000, 1(4): 206.
    [28]张英,李铁兵,孙茂波.参芪合剂抗疲劳作用的基础与临床研究[J].中医药学报. 1998, (4): 35.
    [29]黄兆胜,施旭光,朱伟.黄芪桂枝五物汤及其配伍抗炎镇痛的比较研究[J].中药新药与临床药理. 2005, 16(2): 93-96.
    [30]陈婷.日本中药研究动向[J].中国中药杂志. 1999, 14(3): 33.
    [31]张鸿.白芍总甙的免疫调节作用及机理药理学与毒理学杂志[J]. 1999, 4(3): 190.
    [32]周丹,韩大庆,刘静,等.白芍、赤芍及卵叶芍药滋补强壮作用的研究初探[J].吉林中医药. 1993, 13(2): 38.
    [33]张竹心.生姜油的抗炎作用研究[J].中草药. 1989, 20(12): 545.
    [34]周锡顺.中药大枣对小鼠腹腔巨噬细胞吞噬功能的影响[J].中国实验临床免疫学杂志. 1992, 4(4): 35.
    [35]周海燕,孔建龙,吴大正.黄芪中不同提取成分对在体大鼠心肌缺血再灌注损伤的心功能影响[J].中国中药杂志. 2000, 3(5): 300.
    [36]许东,胡治平,秦毅,等.黄芪注射液对脑出血大鼠细胞凋亡影响的研究[J].临床神经病学杂志. 2008, 21(1): 37-40.
    [37]吴发宝,陈希元.黄芪药理作用研究综述[J].中药材. 2004, 27(3): 232-234.
    [38]谭峰,顾卫,黄涛,等.黄芪对急性脑梗死患者生存质量和细胞免疫功能的影响[J].中医药学刊. 2006, 24(10): 1818-1820.
    [39]齐勇.益气活血法对脑出血大鼠脑内TSP-1、TSP-2及其受体CD36表达的影响[J].中国老年学杂志. 2007, 27(10): 913-916.
    [40]齐勇.益气活血法对脑出血大鼠血肿区血管新生的形态学影响[J].中国康复. 2007, 22(3): 166-168.
    [41]郑强,黄世敬,项宝玉,等.脑血疏通口服液对实验性脑出血大鼠脑水肿及脂质过氧化作用的影响[J].中国中医基础医学杂志. 2000, 6(5): 307-310.
    [42]中国中西医结合学会活血化瘀研究学会主编[M].血瘀证与活血化瘀研究.北京:学苑出版社. 1990: 275.
    [43]刘巨源,陈永凤,郭萍,等.黄芪丹参甘草等中药对大鼠肺纤维化的影响[J].新乡医学院学报. 1999, 16: 292-295.
    [44]孙玉凤,冯志杰,孙泽明,等.黄芪抗肝纤维化的实验研究[J].河北中医药学报. 2008, 23(1): 9-10.
    [45]郭军,刘文超,孟华,等.当归、川芎、丹参、黄芪提取液对肺成纤维细胞的影响.江苏中医药. 2007, 39(5): 59-60.
    [46]左川,谢席胜,樊均明,等.黄芪对单侧输尿管梗阻大鼠肾小管间质病理损害的作用[J].西部医学. 2008, 20(2): 245-248.
    [47]何晓峰,赵晓琴,刘晓城,等.黄芪对左肾静脉狭窄大鼠肾组织病理学与转化生长因子-β1表达的影响[J].医药导报. 2008, 27(5): 508-509.
    [48]邓英辉,林琼真,于洁,等.黄芪注射液改善肾间质纤维化的作用机制研究[J].中国中西医结合肾病杂志. 2008, 9(5): 393-396.
    [49]陶少平,陈学峰,孙艳,等.黄芪注射液对糖尿病肾病患者血转化生长因子-β1及IV型胶原水平的影响及其意义[J].中国中西医结合肾病杂志. 2006, 7(3): 156-157.
    [50]余维巍,刘晓晴.黄芪对油酸诱导的急性肺损伤大鼠肝细胞生长因子表达的影响[J].中华实用中西医杂志. 2004, 4(17): 2134-2136.
    [51]余维巍,刘晓晴.黄芪对内毒素性急性肺损伤大鼠肝细胞生长因子表达的影响[J].中国中西医结合急救杂志. 2005, 12(5): 309-311.
    [52]张平,李杰平,于小华,等.黄芪甲甙对实验性肺纤维化大鼠CB表达的影响[J].现代生物医学进展. 2007, 7(6): 860-862.
    [53]赵桂华,唐其风.黄芪桂枝五物汤对小鼠的免疫调节作用[J].中国冶金工业医学杂志. 2006, 23(6): 708-709.
    [54]户田彭男.黄芪桂枝五物汤对氧化刺激的抑制作用.国外医学-中医中药分册. 1998, (5)3: 6.
    [55]黄兆胜,施旭光,朱伟,等.黄芪桂枝五物汤及其配伍抗炎镇痛的比较研究[J].中药新药与临床药理. 2005, 16(2): 93-96.
    [56]于小华,张新刚,李双杰,等.黄芪甲甙对病毒性心肌炎小鼠心肌柯萨奇-腺病毒受体基因表达的影响[J].实用儿科临床杂志. 2005, 20(3): 215-217.
    [57]王学锋,陈林,钟前进,等.黄芪对氧自由基致肺损伤的保护作用[J].现代中西医结合杂志. 2004, 13:12-l6.
    [58]赵春秀,景有伶,段国贤,等.肠缺血-再灌注损伤时脂质过氧化变化及黄芪的防治作用[J].中国煤炭工业医学杂志. 2003, 6: 22-25.
    [59]顾俭勇,黄培志.黄芪对脂多糖致急性肺损伤的保护机制[J].中国临床医学. 2005, 12(6): 1147-1149.
    [60]于芹超,朱同玉,张永康.黄芪甲甙对大鼠肾缺血再灌注损伤的远期防护作用[J].中华医学杂志. 2004, 84(17): 1412-1415.
    [61]张召才,杨英珍,李双杰,等.黄芪甲甙对病毒性心肌炎小鼠心纤维化的影响[J].中国新药与临床杂志. 2003, 22(9): 515-519.
    [62] Fritsch EW, Heisel J, Rupp S. The failed back surgery syndrome. Reasons, Intraoperative Findings, and Long-term results: A report of 182 operative treatments. Spine. 1996, 21: 626-633.
    [63] Murat Bezer, Osman Guven, Kemal Goku, et al. The influence of vertebral instability on peridural circulation impairment and concomitant peridural firbrosis formation. 6th International Congress on Spinal Surgery September 4-7, 2002, Ankara-Turkey.
    [64]梁裕,张云海,龚耀成.预防椎板切除术后硬膜外瘢痕的实验研究[J].中华创伤杂志. 2000, 16(6): 353-355.
    [1] Songer MN, Ghosh L, Spencer DL. Effects of sodium hyaluronate on peridural fribrosis after lumbar laminectomy and discectomy[J]. Spine. 1990, 15: 550.
    [2]王欢,郝立波,王海义.血肿在硬膜外瘢痕粘连作用的探讨[J].中华骨科杂志. 1998, 18(3): 161.
    [3]沈权,侯筱魁,叶澄宇,等.黄芪预防术后硬膜外粘连的实验研究[J].中国骨伤. 2001, 14(3): 152-153.
    [4]李华南,万小明,邓运明,等.丹参预防椎板切除术后硬膜外粘连的实验研究[J].中医正骨. 2001, 13(12): 6-8.
    [5]陈蓟,肖德明,杨宏图,等.丹参凝胶对椎板切除术后硬膜外粘连的影响[J].中华实验外科杂志. 2006, 23(4): 609-611.
    [6]张兆杰,周卫中.三七凝胶预防椎板切除术后粘连的实验研究[J].中国骨伤. 2007, 20(1): 37-40.
    [7]田晓滨,张一.汉防己甲素预防椎板切除术后硬膜外粘连[J].中国临床康复. 2006, 10(47): 35-38.
    [8]何承建,曾俊华.当归预防椎板切除术后硬膜外粘连的实验研究[J].中国中医骨伤科杂志. 2007, l5(7): 53-55.
    [9]靳安民,闵少雄,高艳杰,等.医用聚乙二醇小檗碱液预防腰椎管术后硬膜外粘连的临床观察[J].黑龙江医学. 2007, 31(3): 201-203.
    [10]王立新,曹晓建.丝裂霉素C对大鼠硬膜外瘢痕组织中羟脯氨酸含量的影响[J].江苏大学学报(医学版). 2005, 15(2): 110-112.
    [11]王立新,张学康,曹晓建,等.不同浓度丝裂霉素C预防椎板切除术后硬膜外粘连的实验研究[J].中国矫形外科杂志. 2007, 15(9): 691-693.
    [12]曹晓建,张宁金,正帅,等.丝裂霉素C和5-氟尿嘧啶预防椎板切除后硬膜外瘢痕粘连的效果比较[J].中华实验外科杂志. 2006, 23(6): 731-732.
    [13]胡丹,惠延年, Philip P.丝裂霉素C抑制人结膜囊成纤维细胞生长及增殖[J].第四军医大学学报. 2001, 22(l3): 1230-1232.
    [14] Kuivila TE, Berry JL, Bell GR, et al.Heparinized materials for control of the formation of the laminectomy membrane in experimental laminectomies in dogs[J]. Clin orthop. 1988, 236: 166-174.
    [15] Selcuklu A, Pasaoglu A, Akdemir H, et al. Urokinase for control of scar formation after laminectomy[J]. Spine. 1993, 18: 165 -168.
    [16] Hinton JL, Warejcka DJ, Mel Y, et al. Inhibition of epidural scar formation afterlumbar laminectomy in the rat[J]. Spine. 1995, 20: 564-570.
    [17] Jacobs RR, McClain O, Neff J. Control of postlaminectomy scar formation. An experimental and clinical study[J]. Spine. 1980, 5: 223-229.
    [18]汪良能,高学书主编.整形外科学.北京人民卫生出版社. 1989: 333.
    [19]周正新,丁锷.活血通络汤治疗腰椎间盘突出症术后麻木综合征临床观察[J].中医正骨. 2002, 14(2): 14.
    [20]睦承志,邓福树.脊痛消胶囊治疗腰椎间盘突出症术后疼痛综合症疗效观察[J].中医正骨. 1996, 8(6): l3.
    [21]韩元龙,姜江.髓核摘除术后配合补阳还五汤治疗腰椎间盘突出症[J].中国中医骨伤科. 1995, 3(4): 33.
    [22]陈可冀,张之南,梁子钩主编.血淤证与活血化淤研究[M].上海:上海科学技术出版社. 1990: 125-127.
    [23]周辉,郑悦亮.活血止痛汤对兔硬膜外瘢痕中TGF-B1表达的影响[J].中国中医骨伤科杂志. 2005, 13(2): 7-9.
    [24]刘向前,段戡,罗毅文,等.活血化瘀中药预防腰椎手术失败综合征[J].湖南中医学院学报. 1997, l7(6): 34.
    [25]刘向前,陈曙,梁红锁.化瘀消肿方对兔椎板切除术后硬膜外瘢痕组织中羟脯氨酸含量的影响[J].湖南中医报. 2004, 24(1): 24-25.
    [26]杨泰峰.中药治疗腰椎间盘突出症术后疼痛32例报告[J].中国中医骨伤科. l 994, 9(4): 45.
    [27]白玉,杜良杰,韩麦群.保护硬膜外脂肪配合身痛逐瘀汤防止椎板切除术后硬膜外瘢痕粘连[J].中医正骨. 2000, 12(6): 29.
    [28]于沈敏,吴军豪,石仰山,等.石氏牛蒡子汤治疗腰椎间盘突出症术后40例[J].中国骨伤. 1997, 10(6): 48.
    [29]高峰,王亚斌.腰椎间盘突出症术后并发症的中药预防[J].中国骨伤. l997, l0(6): 49.
    [30]刘诗荣,姜卫周,李凤春.腰椎间盘突出症术后足趾麻木症的原因及预防[J].中医正骨. 1999, l1(3): 23.
    [31]李振宇,王丹芳,宋鹏程,等.腰椎间盘突出症术后复发的机理与手法治疗[J].中医正骨. 1997, 9(3): 6.
    [32] He Y, Revel M, Loty B. A quantitative model of post-laminectomy scar formation: Effects of a nonsteroidal anti-inflammatory drug[J]. Spine. 1995, 20(5): 557.
    [33] Masato Nakano, Hisao Matsui, Kentaro Miaki, et al. Post-laminectomy adhesion of the Cauda Equina inhibitory effects of anti-inflammatory drugs on Cauda Equinaadhesion in rats[J]. Spine. 1998, 23(3): 298-304.
    [34]梁裕,张云海,龚耀成,等.预防椎板切除术后硬膜外瘢痕的实验研究[J].中华创伤杂志. 2000, 16(6): 353-355.
    [35]杨茂伟,胡宝山.塞来昔布预防椎板切除术后硬脊膜外粘连的研究[J].中国现代医学杂志. 2003, 13(l6): l2-l4.

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700