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目的探讨建立猪脊髓、神经根轴性牵拉损伤模型模拟脊髓栓系综合征的方法。方法将18只成年家猪随机分为3组,每组6只。假手术组:暴露L1~5脊髓;对照组:暴露L1~5脊髓后于L1~5双侧椎弓根置入螺钉;实验组:暴露L1~5脊髓并于双侧椎弓根置入螺钉后,均匀撑开L1~5椎间隙。于各时间点对3组动物行X线片、后肢行为学、尿流动力学、体感诱发电位、激光散斑血流成像及组织病理学检查并对结果进行比较分析。结果假手术组和对照组术前、术后L1~5椎体间高度、后肢运动神经功能评分、尿流动力学、体感诱发电位及激光散斑血流成像检查结果均无明显变化,组织学观察脊髓、神经结构基本正常。实验组动物撑开后L1~5的椎体间高度较撑开前增高,后肢运动神经功能评分降低,体感诱发电位P波的潜伏期延长、波幅下降,脊髓表面的血流减少(P<0.05);撑开后出现低顺应性膀胱、逼尿肌-括约肌协同功能障碍;脊髓组织可见不同程度的神经细胞坏死,胞质内可见颗粒变性和空泡变性;神经根组织可见组织水肿、细胞结构疏松,部分神经束膜损伤。结论通过松解猪腰椎后柱结构均匀撑开椎间隙的方法可以建立脊髓、神经根轴性牵拉损伤模型,该模型能够模拟临床脊髓栓系综合征患者的下肢感觉、运动功能和括约肌功能障碍,为深入探讨脊髓栓系综合征的病理机制以及手术治疗方式奠定了实验基础。
Objective To establish a method to simulate tethered spinal cord syndrome in pigs with spinal cord and nerve root traction model. Methods 18 adult domestic pigs were randomly divided into 3 groups, 6 in each group. In the sham operation group, L1 ~ 5 spinal cord were exposed. In the control group, screws were inserted into the bilateral pedicles of L1 ~ 5 after exposed L1 ~ 5 spinal cord. In the experimental group, L1 ~ 5 spinal cord were exposed and screw After evenly spread open L1 ~ 5 intervertebral space. The X-ray, hindlimb behavior, urodynamics, somatosensory evoked potentials, laser speckle flow imaging and histopathological examination of the three groups of animals were performed at different time points and the results were compared. Results There was no significant change in L1 ~ 5 intervertebral body height, hindlimb motor nerve function score, urodynamics, somatosensory evoked potential and laser speckle flow imaging before and after operation in sham operation group and control group. Histological observation Spinal cord, nerve structure is normal. In the experimental group, the intervertebral body height of L1 ~ 5 was higher than that before propping up, the score of motor neurological function of hindlimb was decreased, the latency of somatosensory evoked potential P wave was prolonged, amplitude was decreased and the blood flow of spinal cord surface was decreased (P <0.05) ; Low compliance bladder, detrusor - sphincter synergistic dysfunction after splayed open; necrosis of nerve cells in varying degrees in spinal cord tissue, granular degeneration and vacuolar degeneration in cytoplasm; tissue edema in nerve root tissue, loose cell structure , Partial nerve membrane injury. Conclusions Spinal cord and nerve root stretch injury model can be established by releasing the posterior column structure of porcine lumbar vertebral column evenly. This model can simulate the lower extremity sensory function, motor function and sphincter dysfunction in patients with clinical tethered cord syndrome , Which laid the experimental foundation for further exploration of the pathological mechanism of tethered cord syndrome and surgical treatment.