甲基强的松龙在复杂寰枕部畸形合并严重压迫性脊髓病手术患者中的应用价值  

The clinical evaluation of high-dose intravenous methylprednisolone on complex craniocervical junction malformation with severe compression myelopathy treated surgically

作　　者：王冰[1] 吕国华[1] 尹刚辉[1] 刘伟东[1] 李晶[1] 康意军[1] 马泽民[1] 

机构地区：[1]中南大学湘雅二医院脊柱外科,长沙市410011

出　　处：《中国脊柱脊髓杂志》2007年第8期615-618,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:评价甲基强的松龙(MP)在复杂寰枕部畸形合并严重压迫性脊髓病手术患者中的应用价值。方法:2004年1月-2005年12月共收治复杂寰枕部畸形合并严重性压迫性脊髓病患者62例,分为MP治疗组和对照组。治疗组32例,19例术前无限制性通气功能障碍者在脊髓减压前30min按20mg/kg冲击,术后第1、2、3天均按3mg/kg/d静滴;13例术前合并限制性通气功能障碍者脊髓减压前30min按30mg/kg冲击,其后按5.4mg/kg/h静滴,持续23h后停用。对照组30例,术后均即刻应用20%甘露醇125ml,1次/8h;地塞米松20mg/d静滴,共3d,第4天减至10mg,第5天减至5mg,5d后停用。评价患者脊髓功能恢复情况、自主呼吸恢复时间和并发症情况。结果:MP治疗组术后3d、7d和术后3个月的JOA评分均较术前明显提高(P<0.05);对照组术后3d和3个月与术前比较有明显提高(P<0.05),术后7d与术前比较无明显差异(P>0.05);MP治疗组术后7d的JOA评分高于对照组,差异有统计学意义(P<0.05)。合并限制性通气功能障碍者应用MP自主呼吸功能恢复时间与对照组比较明显缩短(P<0.05)。两组均未发生感染、心血管和消化道出血等并发症。结论:外科减压治疗复杂寰枕部畸形合并严重压迫性脊髓病是改善脊髓神经功能的有效方式,同时应用MP可有效维持减压后获得改善的脊髓神经功能,并有助于减压后患者自主呼吸功能的恢复。Objective：To evaluate the clinic effects of high-dose intravenous methylprednisolone on complex craniocervical junction malformation with severe compressional myelopathy treated surgically.Method：62 patients with complex craniocervical junction malformation between January 2004 and October 2005 were divided into 2 groups,MP group（n=32） and Control group（n=30）.In the MP group,16 cases without restrict ventilation functional disturbance：MP 20mg/kg within 30min before the decompression and 3mg/kg/d within 1,2,3 days after operation were administrated.13 cases with restrict ventilation functional disturbance：MP 30mg/kg within 30 min before the decompression and 5.4mg/kg/h within 23h after operation were administrated.All the cases in the control group were given 20% mannitol and dexamethasone （DXM） via intravenous and maintained for 5d.The JOA scores,spontaneously respiratory recovery time （SRRT） and complications were compared between each group.Result：The JOA scores were improved in MP group at 3d,7d and 3 months and in the control group at 3d and 3 months after surgery,which had statistical difference compared with preop- eration（P〈0.05） ,and in the control group there no statistics fifference at 7d after surgery.There were statistical difference with respect to JOA scores at 7th day after surgery between MP group and control group （P〈0.05）. The cases with restrict ventilation functional disturbance in the MP group had shorter SRRT than those in control group （P〈0.05）.There were no severe complications in the two groups.Conclusion：The surgical treatment of the craniocervical junction malformation with severe compressional myelopathy is an effective method to improve neurological function,combined use of MP is useful for maintaining neurological function and shortening the SRRT.

关 键 词：甲基强的松龙 寰枕部畸形 压迫性脊髓病 

分 类 号：R682.1[医药卫生—骨科学] R977.1[医药卫生—外科学]