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Perbandingan jumlah sel mononuklear, jumlah sel fibroblas, ukuran fibrosis, dan perlengketan klinis jaringan peridural pasca prosedur kraniektomi dekompresi dengan dan tanpa proceed surgical mesh pada kelinci new zealand cedera otak traumatik

Abstract

Latar Belakang: Salah satu penyebab utama komplikasi dan kematian yang timbul akibat cedera otak traumatika adalah hipertensi intrakranial. Terapi untuk mengendalikan peningkatan tekanan intrakranial (TIK) adalah dengan melakukan tindakan kraniektomi dekompresi sebelum tindakan definitif. Komplikasi yang sering ditemukan setelah kraniektomi dekompresi adalah adanya perlengketan/adhesi. Penggunaan proceed surgical mesh sebagai membran bioabsorbable diperkirakan mampu mencegah terjadinya fibrin bridge formation dan adhesi. Penelitian ini bertujuan untuk membuktikan efek tindakan kraniektomi dekompresi dengan proceed surgical mesh terhadap jumlah sel mononuklear, jumlah sel fibroblas, ukuran fibrosis dan perlengketan klinis pada jaringan peridural kelinci new zealand dengan cedera otak traumatik.

Metode: Penelitian ini menggunakan model binatang dengan rancangan the randomized post-test only control grup design. Sebanyak 20 sampel yang memenuhi kriteria dilibatkan dalam penelitian dan dilakukan randomisasi. Sebanyak 10 sampel dikelompokkan sebagai kelompok kontrol yaitu kelompok kelinci new zealand pascaoperasi kraniektomi dekompresi tanpa proceed surgical mesh dan kelompok perlakuan yaitu kelompok kelinci new zealand pascaoperasi kraniektomi dekompresi dengan proceed surgical mesh. Pada hari ke 28 dilakukan euthanasia dan pengambilan jaringan peridural untuk pemeriksaan jumlah sel mononuklear, jumlah sel fibroblas, dan ukuran fibrosis. Jumlah sel mononuklear, jumlah sel fibroblas dan ukuran fibrosis diperiksa dengan tehnik histopatologis. Perlengketan klinis dinilai dari adanya perlengketan antara duramater dengan jaringan otot temporalis, fascia atau kulit di atasnya. Uji hipotesis menggunakan uji independent t test dan Mann Whitney untuk data berskala numerik dan uji Chi Square untuk data berskala katagorik, dengan tingkat kemaknaan adalah p<0,05.

Hasil: Dari hasil penelitian didapatkan rerata jumlah sel mononuklear lebih rendah pada kelompok perlakuan (6,7±4,8 sel/LP) dibandingkan kelompok kontrol (7,0±3,0 sel/LP). Berdasarkan hasil analisis perbedaan ini tidak bermakna secara statistik (p=0,481). Rerata jumlah sel fibroblas lebih rendah pada kelompok perlakuan (15,5±4,1 sel/LP) dibandingkan  kelompok kontrol (17,8±5,3 sel/LP). Berdasarkan hasil analisis perbedaan ini tidak bermakna secara statistik (p= 0,292). Rerata ukuran fibrosis menunjukkan perbedaan yang bermakna dimana lebih rendah pada kelompok perlakuan (549,4±309,1μm) dibandingkan kelompok kontrol (830,9±342μm) dengan p=0,023.  Kelompok perlakuan dengan menggunakan proceed surgical mesh secara bermakna dapat mencegah 89% terjadinya perlengketan klinis (p<0,001).

Simpulan: Tindakan kraniektomi dekompresi dengan proceed surgical mesh secara bermakna menyebabkan ukuran fibrosis dan risiko perlengketan klinis lebih rendah pada jaringan peridural kelinci new zealand dengan cedera otak traumatika.

 

 

Introduction: One of the main causes of complications and deaths arising from traumatic brain injury is intracranial hypertension. Therapy to control the increase in intracranial pressure (TIK) is to perform a decompressive craniectomy before definitive treatment. A common problem after decompressive craniectomy is adhesion. The use of proceed surgical mesh as a bioabsorbable membrane is estimated to be able to prevent the occurrence of fibrin bridge formation and adhesion. This study aims to prove the effects of decompressive craniectomy with proceed surgical mesh on mononuclear cells counts, fibroblast cell counts, fibrosis size and clinical adhesions in the peridural of new zealand rabbits with traumatic brain injury. Method: This research uses animal model with randomized post-test only control group design. A total of 20 samples that met the eligibility criteria were included in the study and randomized. A total of 10 samples were grouped as a control group namely the new zealand rabbit group after decompressive craniectomy without proceed surgical mesh and 10 samples the treatment group namely the new zealand rabbit group after decompressive craniectomy with proceed surgical mesh. On day 28, we performed euthanasia and peridural tissue were taken for examination of mononuclear cells counts, fibroblast cell count, and fibrosis size. Mononuclear cells counts, fibroblast cells counts and the size of fibrosis was examined with histopathological techniques. Clinical adhesions is judged by the adhesions between the duramater and the temporalis muscle tissue, fascia or the overlying skin. Hypothesis test using unpaired t test and Mann-Whitney for numerical scale data and Chi Square test for categoric scale data, with significance level p <0,05.Result: From the results of the study it was found that the mean number of mononuclear cell counts was lower in the treatment group (6.7 ± 4.8 cells / LP) than the control group (7.0 ± 3.0 cells / LP).Based on the results of the analysis this difference was not statistically significant (p = 0.481). The mean number of fibroblast cells was lower in the treatment group (15.5 ± 4.1 cells / LP) than in the control group (17.8 ± 5.3 cells / LP).Based on the results of the analysis, this difference was not statistically significant (p = 0.292). The mean fibrosis size showed a significant difference which was lower in the treatment group (549.4 ± 309.1μm) than the control group (830.9 ± 342μm) with p = 0.023.The treatment group by using proceed surgical mesh can significantly prevent 89% of clinical adhesions (p <0.001).Conclusion: Decompressive craniectomy with proceed surgical mesh significantly causes lower fibrosis size and lower risk of clinical adhesions in the peridural new zealand rabbits with traumatic brain injury.

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How to Cite

Mahendra, K. Y. F., Niryana, I. W., & Golden, N. (2019). Perbandingan jumlah sel mononuklear, jumlah sel fibroblas, ukuran fibrosis, dan perlengketan klinis jaringan peridural pasca prosedur kraniektomi dekompresi dengan dan tanpa proceed surgical mesh pada kelinci new zealand cedera otak traumatik. Medicina, 50(2). https://doi.org/10.15562/medicina.v50i2.805

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