鼠神经生长因子联合甲钴胺治疗未行激素冲击治疗的急性不完全性脊髓损伤  

Combination of mouse nerve growth factor and mecobalamin for treatment of incomplete spinal cord injury without high-dose methylprednisolone therapy

作　　者：林红[1] 李超[1] 姜允琦[1] 马易群[1] 李熙雷[1] 周晓岗[1] 董健[1] 

机构地区：[1]复旦大学附属中山医院骨科,上海200032

出　　处：《中华创伤骨科杂志》2012年第3期207-210,共4页Chinese Journal of Orthopaedic Trauma

基　　金：上海市医学重点项目（09411953800）;上海市科委“科技创新行动计划”重点项目（08411952500）;七海市医学领军人才项目（LJ10017）;闰家自然科学基金（30970718）;上海市国际科技合作项目（11540702700）

摘　　要：目的探讨鼠神经生长因子（mNGF）联合甲钴胺在对未行激素冲击治疗的急性胸腰椎骨折合并不完全性脊髓损伤（ISCI）患者中的直用价值。方法对2007年10月至2010年9月伤后8h未进行激素冲击治疗的急性胸腰椎骨折合并ISCI的56例患者资料进行回顾性分析，按照术后处理方法不同分为2组：mNGF联合甲钻胺组（联合组，28例）和单纯使用甲钴胺组（单纯组，28例）。比较术后恢复情况，比较两组患者治疗前、治疗后1周、8周及12个月美国脊髓损伤协会（ASIA）标准的神经功能评分、日常生活活动（ADL）评分及神经功能改善率。结果所有患者获12～48个月（平均20个月）随访，无患者死亡，无创口感染；术后平均10个月植骨获融合。治疗后1周、8周及12个月两组神经功能评分及ADL评分均明显高于治疗前，除单纯组在1周时神经功能评分差肄无统计学意义（P〉0．05），余差片均钉统计学意义（P〈0．05），且治疗后联合组各时间点评分均优于单纯组，差异有统计学意义（P〈0．05）术后1周、8周及12个月联合组的神经功能改善率分别为32．1％（9／28）、82．1％（23／28）和92．9％（26／28），均优于单纯组的25．0％（7／28）、50．0％（14／28）和71．4％（20／28），其中8周和12个月差异有统计学意义（P〈0．05）。结论与单纯应用甲钻胺比较，mNGF与甲钴胺联合治疗ISCI可促进脊髓损伤的恢复，改善神经功能。[Abstract] Objective To evaluate the clinical efficacy of mOtlse nerve growth factnr （mNGF） plus meeobalanlin in lhe treatment of incomplete spinal cord injury （ISCI） without high-dose methylprednisolone Methods From October 2007 to September 2010. 72 ISCI patients （Frankel grades B, C ＆ D） without previous high-dose methylprednisolone therapy were treated in our department, of whom 56 were retro- spectively selected ft^r the prese^t study and divided into 2 groups, h~ group A 28 patients were treated with comhination of mN（;F and mecobalamin; 28 patients in group B were treated with mecobahnnin only. In this se- ries. American Spinal hljury Association （ASIA） impairment scale and Activity of Daily Living （AI）L） evaluation were used to observe and calculate nerve function improvement preoperation and 1 week, 8 weeks, 12 months poslnperation. Results The mean follow-up period was 20 nnmths （from 12 to 48 months）. No mortality or incision infeetion was observed. Fusions of bone graft were observed 10 months postoperation on average. The ASIA and AI）L scores at I week, 8 weeks and 12 months postoperalion were significant higher than those preop- eration in both groups （ P 〈 O. 05） except the ASIA score 1 week postuperation in group B. The postoperative ASIA and AI）L scores in Group A were all significantly higher than those in group B （P 〈 0.05）. The nerve function improvement at 1 week. 8 weeks and 12 months postoperation in group A were 32. 1% （9/28）, 82. 1 v,~ （23/28） and 92.9% （26/28） respectively, which were better than those in group B [25.0% （7/28）, 50.0% （14/28/ and 71.4% （20/28）I, with a significant difference at 8 weeks and 12 months postoperation（ P 〈 O. 05）. Conclusion Compared with administration of sole mecobalamin, combination of mNGF and meeolmlamin proves to he highly effective in promoting ISC1 recovery and improving nerve functiont. [Key words] Spinal cord injury;Mouse;Neve growth ;Mecobalamin;Nerve funtion; Nerve growth f

关 键 词：脊髓损伤 鼠 神经生长因子 甲钴胺 神经功能 

分 类 号：R651.2[医药卫生—外科学]