甲基强的松龙对腰椎间盘突出症手术效果的影响  

The effect of methylprednisolonum on result of prolapsed lumbar disc surgery

作　　者：陈滨[1] 冯宇[1] 王涵韬[1] 

机构地区：[1]上海交通大学医学院附属仁济医院骨科,上海200127

出　　处：《临床骨科杂志》2015年第5期552-555,共4页Journal of Clinical Orthopaedics

摘　　要：目的：观察围手术期糖皮质激素对腰椎间盘突出症髓核摘除手术效果的影响。方法采用髓核摘除手术治疗77例单侧单节段腰椎间盘突出症患者,根据入院顺序分成3组,髓核摘除术后使用不同糖皮质激素。A组术后静脉应用甲基强的松龙,B组术后静脉应用甲基强的松龙加局部使用甲基强的松龙,C组术后静脉应用地塞米松。术后对患者采用JOA评分、VAS评分进行随访。结果77例患者均获得随访,时间12~14个月。术后所有患者伤口均甲级愈合,没有发生继发感染和应激性溃疡。术后局部使用甲基强的松龙的患者在术后1周恢复优于其他两组（P〈0．01）；应用甲基强的松龙在术后2周效果好于应用地塞米松（P〈0．01、P〈0．05）,但术后3个月及1年随访两者差异无统计学意义（P〉0．05）。结论糖皮质激素的使用可以显著改善腰椎间盘突出症的手术效果。局部应用甲基强的松龙可以有效缓解术后疼痛、促进功能恢复,预防术后临床症状反跳的发生。静脉使用甲基强的松龙短期内效果优于地塞米松,术后3个月及1年随访3组效果无明显差异。Objective To evaluate the effect of corticosteroid on result of prolapsed lumbar disc surgery. Methods 77 consecutive patients with ipsilateral monosegmental prolapsed lumbar disc treated with discectomy were divided in-to three groups according to admission sequence, and followed up after intravenous methylprednisolonum （ Group A） , intravenous plus local methylprednisolonum （ Group B） and intravenous dexamethasone treatment （ Group C） respec-tively. JOA scores and VAS scores were collected in the follow-up. Results All 77 patients were followed up for 12~14 months and all incisions were well healed without infection and ulcer. The short-term outcome （ within 1 week after operation） of local methylprednisolonum group was better than the other two groups （P〈0. 01）;the short-term outcome （within 2 weeks after operation） of methylprednisolonum was better than dexamethasone（P 〈0. 01,P 〈0. 05）;however, there was no significant difference in long-term outcome （P〉0. 05）. Conclusions The result of lumbar disc surgery can be greatly improved by corticosteroid. The local use of methylprednisolonum is effective in al-leviating postoperative pain, improving function recovery and preventing the recurrence of symptoms after surgery. Comparing with dexamethasone, the effect of intravenous methylprednisolonum is better in short term. However, there is no significant difference in long-term follow up.

关 键 词：甲基强的松龙 腰椎间盘突出症 椎间盘切除术 

分 类 号：R681.5[医药卫生—骨科学] R969.4[医药卫生—外科学]