脊髓型颈椎病围手术期应用不同剂量甲基强的松龙的疗效观察  

Effect of perioperative use of different dose of methyloprednisonlone on cervical spondylotic myelopathy

作　　者：周盛源[1] 陈雄生[1] 贾连顺[1] 朱巍[1] 黄剑侯[1] 房雷[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海市凤阳路415号200003

出　　处：《中国脊柱脊髓杂志》2009年第1期56-59,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的：探讨不同剂量甲基强的松龙（MP）在脊髓型颈椎病围手术期应用的效果。方法：2005年10月～2006年10月将80例临床确诊为脊髓型颈椎病（CSM）患者随机均分为A、B、C、D组,每组20例,所有患者均由同一组外科医生行颈椎前路减压植骨融合内固定手术。减压前30min开始静脉滴注MP,A组1000mg、B组500mg、C组200mg;三组术后第1、2天静脉滴注MP120mg,1次/日,术后第3、4天静脉滴注MP80mg,1次/日,术后第5、6天静脉滴注MP40mg,1次/日。D组不用糖皮质激素。对各组术前和术后1周、3个月、6个月神经功能进行JOA评分,观察各组消化道症状、精神异常等并发症发生情况,并分别进行统计学分析。结果：A、B、C组术后1周JOA评分与术前比较均明显提高（P〈0.05）,D组术后1周与术前比较无显著性差异（P〉0.05）,每组术后3个月、6个月与术前比较均明显提高（P〈0.05）,每组术后3个月与术后1周比较及术后6个月与术后3个月比较均明显提高（P〈0.05）;术前、术后6个月各组JOA评分均无显著性差异（P〉0.05）;术后1周、3个月A组、B组与D组比较有显著性差异（P〈0.05）,C组与D组比较无显著性差异（P〉0.05）,A组、B组与C组比较及A组与B组比较均无显著性差异（P〉0.05）。A组10例出现消化道症状,其中2例合并精神症状,2例出现单纯精神症状;B组4例出现消化道症状,其中2例合并精神症状;C组3例出现消化道症状,其中合并精神症状1例;D组未出现消化道症状和精神症状。A组并发症发生例数明显多于其他各组（P〈0.0125）,B组并发症发生例数与C组比较无显著性差异（P〉0.0125）。结论：CSM患者围手术期采用MP首剂500mg方案与1000mg方案均可促进术后3个月内的神经功能恢复,但首剂500mg方案的并发症较1000mg方案少。Objective：To evaluate the effect of perioperative use of different dose of methyloprednisonlone（MP） on cervical spondylotic myelopathy （CSM）.Method：80 cases diagnosed of CSM from October 2005 to October 2006 were randomized into 4 groups with 20 cases in each group.All cases underwent the same surgical protocol of anterior cervical decompression and fusion with instrument.1000mg MP was administered intravenously 30 minutes before decompression in group A,500mg MP in group B and 200rag MP in group C,which were reduced gradually with the same protocol（120mg at 1-2th days after surgery,80mg at 3-4th days,40mg at 5- 6th days）.No glucocorticoid was used pre and postoperatively in group D as control.The neurological functions were graded according the JOA score system preoperatively and in 1 week,3 months and 6 months postoperatively,and the results were analyzed statistically.The occurrence of complication such as gastrointestinal and psychiatric symptoms in each group were reviewed retrospectively.Result：Compared with preoperation,JOA scores of group A,B and C at 1st week postoperatively improved obviously（P〈0.05） except group D（P〉0.05）. Among each group,JOA scores of 3 and 6 months postoperatively were higher than those preoperatively （P〈 0.05） ,with the same manner of 3 month via 1 week postoperatively and 6 month via 3 month postoperatively （P〈O.05） ,JOA scores among each group preoperatively and 6 months postoperatively had no statistical difference（P〉0.05）,and also no statistical difference were observed among group A,B and C at all timepoint.JOA scores of group A and B were higher than those of group D at 1 week and 3 months postoperatively （P〈 0.05）.JOA score of group C was higher than those of group D at 1 week and 3 months postoperatively with no statistical difference （P〉0.05）.In group A,8 cases were complicated with gastrointestinal symptoms,2 cases with gastrointestinal and psychiatric symptoms and 2 cases with psychiatric symptoms. While in grou

关 键 词：脊髓型颈椎病 甲基强的松龙 围手术期 

分 类 号：R681.5[医药卫生—骨科学] R459.1[医药卫生—外科学]