Derive edilmiş yüksek viskoziteli hiyalüronik asid'in spinal epidural fibrozis üzerine etkisi: Deneysel çalışma
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Date
2013
Authors
Işık, Semra
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Publisher
Uludağ Üniversitesi
Abstract
Epidural fibrozis; epidural mesafe ile birlikte sinir köklerinin fibroblastik invazyona uğramasıdır. Bu yoğun fibröz doku, cerrahi sonrası bel ağrısı, radiküler ağrı semptomlarına neden olmasının yanı sıra, sonradan gerekebilecek bir operasyonda intraspinal yapıların diseksiyonunu da zorlaştırmaktadır.Epidural fibrozis gelişimini önlemek için, cerrahi teknikler ve çeşitli tıbbı tedaviler uygulanmıştır. Bir glikozaminoglikan olan hiyalüronik asid oligomerlerinin oto-çapraz bağlanması ile elde edilen derive edilmiş yüksek viskoziteli hiyalüronik asidin; obstetrik, jinekolojik ve abdominal cerrahide yapışıklık ve sikatris oluşumunun engellenmesi ile yara iyileşmesinin erken fazlarında rolü olduğu gösterilmiştir.Oluşturduğumuz deneysel laminektomi - diskektomi modeli ile derive edilmiş yüksek viskoziteli hiyalüronik asidin epidural fibrozisi önlemede histopatolojik ve biyokimyasal etkilerinin incelenmesi ve araştırılması amaçlandı.Çalışmamıza 60 adet, Sprague-Dawley dişi sıçan alındı. Ancak cerrahi sırasında dural yaralanma meydana gelen 3 denek ile hematom gelişen 1 denek çalışma dışı bırakıldı. Son değerlendirme 56 denek ile yapıldı. Denekler; 1. grup (Sham grubu, n=14); laminektomi ve diskektomi yapılıp mesafeye herhangi bir madde uygulanmayan, 2. grup (Kontrol grubu, n=14); laminektomi ve diskektomi yapılıp mesafeye topikal % 0,9 NaCl uygulanan, 3. grup [Hiyalüronik asid (HA) deney grubu, n=14 ], laminektomi ve diskektomi yapılıp operasyon sahasına topikal hiyalüronik asid uygulanan ile 4. grup [Derive edilmiş yüksek viskoziteli hiyalüronik asid (HA gel) deney grubu, n=14]; laminektomi ve diskektomi yapılıp operasyon sahasına topikal derive edilmiş yüksek viskoziteli hiyalüronik asid uygulanan grup olarak dört gruba ayrıldı. Tüm denekler 4. haftanın sonunda dekapite edilip epidural fibröz dokunun biyokimyasal ve histopatolojik incelemeleri yapıldı. Sonuçlar istatistiksel olarak karşılaştırıldı.iiiDerive edilmiş yüksek viskoziteli hiyalüronik asidin uygulandığı grupta sham ve kontrol grubuna oranla epidural fibrozis, dural adezyon, fibroblast hücre yoğunluğu ile doku hidroksiprolin düzeylerinin belirgin olarak az olduğu izlendi (p < 0,05). Grup 3 ve 4 arasında ise histopatolojik skorlara ve biyokimyasal değerlere bakıldığında anlamlı bir farklılık saptanmadı (p > 0,05).Sonuç olarak; derive edilmiş yüksek viskoziteli hiyalüronik asidin laminektomi sonrası gelişen epidural fibrozis ile oluşan fibrotik doku yoğunluğunun azaltılmasında olumlu etkileri gözlenmiştir. Bu çalışmanın öncülüğünde yapılacak daha ileri deneysel ve klinik çalışmalar ile elde edilecek sonuçların klinik pratikte uygulama alanları bulması ile epidural fibrozisin önlenmesinde önemli yol alınacağı kanaatindeyiz.
Epidural fibrosis is fibroblastic invasion of nerve roots into the epidural space. Formation of dense fibrous tissue causes lumbar and radicular pain. In addition to radicular symptoms, scar tissue may cause problems during redo surgery.Several surgical techniques and medical treatments have been extensively studied to prevent epidural fibrosis development. Crosslinkedhigh molecular weight hyaluronic acid, a glucosaminoglican which is obtained by auto-crosslinking of hyaluronic acid oligomers, has been shown to play a role in prevention of fibrosis and scar formation, therefore early phases of wound healing in obstetrics, gynecology and abdominopelvic surgery. By this laminectomy - discectomy model we aimed to investigate effects of crosslinked high molecular weight hyaluronic acid on prevention of epidural fibrosis, by using histopathological and biochemical parameters.A total of 60 adult female Sprague-Dawley rats were used in this study. However, 4 rats were excluded due to peroperative dural tear or hematoma formation. The final evaluation was done by 56 rats. They were divided into four groups; group 1 (Sham group, n=14); underwent laminectomy and discectomy, and was not given any treatment, group 2 (Control group, n=14); were laminectomized and discectomized, and 0.9 % NaCl was applied on the surgical area, group 3 [Hyaluronic acid (HA) group, n=14]; hyaluronic acid was applied to surgical area after identical surgical procedure, group 4 [crosslinked high molecular weight hyaluronic acid (HA gel) group, n=14]; underwent laminectomy and discectomy, and crosslinkedhigh molecular weight hyaluronic acid was applied to surgical area. All ras were decapitated after 4 weeks and groups were evaluated vhistopathologically and biochemically. Results were statistically compared with Mann-Whitney U test.Compared with sham and control groups, significantly less epidural fibrosis, dural adhesion, fibroblast cell density, and tissue hidroxyprolin concentrations were observed in the group treated with topical crosslinkedhigh molecular weight hyaluronic acid (p < 0.05). There were no significant differences in any histopathological parameters and biochemical values between Group 3 and 4 (p > 0.05).In conclusion, positive effects of crosslinked high molecular weight hyaluronic acid in prevention of epidural fibrosis and reduction of fibrotic tissue density were observed. The efficacy of this agent should also be supported with further experimental and clinical studies
Epidural fibrosis is fibroblastic invasion of nerve roots into the epidural space. Formation of dense fibrous tissue causes lumbar and radicular pain. In addition to radicular symptoms, scar tissue may cause problems during redo surgery.Several surgical techniques and medical treatments have been extensively studied to prevent epidural fibrosis development. Crosslinkedhigh molecular weight hyaluronic acid, a glucosaminoglican which is obtained by auto-crosslinking of hyaluronic acid oligomers, has been shown to play a role in prevention of fibrosis and scar formation, therefore early phases of wound healing in obstetrics, gynecology and abdominopelvic surgery. By this laminectomy - discectomy model we aimed to investigate effects of crosslinked high molecular weight hyaluronic acid on prevention of epidural fibrosis, by using histopathological and biochemical parameters.A total of 60 adult female Sprague-Dawley rats were used in this study. However, 4 rats were excluded due to peroperative dural tear or hematoma formation. The final evaluation was done by 56 rats. They were divided into four groups; group 1 (Sham group, n=14); underwent laminectomy and discectomy, and was not given any treatment, group 2 (Control group, n=14); were laminectomized and discectomized, and 0.9 % NaCl was applied on the surgical area, group 3 [Hyaluronic acid (HA) group, n=14]; hyaluronic acid was applied to surgical area after identical surgical procedure, group 4 [crosslinked high molecular weight hyaluronic acid (HA gel) group, n=14]; underwent laminectomy and discectomy, and crosslinkedhigh molecular weight hyaluronic acid was applied to surgical area. All ras were decapitated after 4 weeks and groups were evaluated vhistopathologically and biochemically. Results were statistically compared with Mann-Whitney U test.Compared with sham and control groups, significantly less epidural fibrosis, dural adhesion, fibroblast cell density, and tissue hidroxyprolin concentrations were observed in the group treated with topical crosslinkedhigh molecular weight hyaluronic acid (p < 0.05). There were no significant differences in any histopathological parameters and biochemical values between Group 3 and 4 (p > 0.05).In conclusion, positive effects of crosslinked high molecular weight hyaluronic acid in prevention of epidural fibrosis and reduction of fibrotic tissue density were observed. The efficacy of this agent should also be supported with further experimental and clinical studies
Description
Keywords
Derive edilmiş yüksek viskoziteli hiyalüronik asid, Epidural fibrozis, Hidroksiprolin, Hiyalüronik asid, Laminektomi, Crosslinked high molecular weight hyaluronic acid, Epidural fibrosis, Hidroxyprolin, Hyaluronic acid, Laminectomy
Citation
Işık, S. (2013). Derive edilmiş yüksek viskoziteli hiyalüronik asid'in spinal epidural fibrozis üzerine etkisi: Deneysel çalışma. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.