甲基强的松龙在脊髓型颈椎病外科治疗中的应用价值

目的:探讨甲基强的松龙(MP)的不同剂量和用法对脊髓型颈椎病患者脊髓减压术后神经功能恢复的影响。方法:脊髓型颈椎病患者87例,根据MP不同剂量和用法分为4组,A组:小剂量术后组,22例;B组:大剂量术中组,25例;C组:大剂量术后组,24例;D组:未用MP组,16例。术后近期(1周)、远期(半年)按日本骨科协会(JOA)评分计算4组患者的神经功能恢复率,统计并发症。远期神经功能评分增加按ODOM分级评分。结果:A、D组分别和B、C组比较有显著性差异(P<0.01),A组与D组、B组与C组比较无显著性差异(P>0.05)。4组均未发生创口和肺部感染,B组发生1例胃大部切除吻合口溃疡,C组1例出现黑便。各组远期随访未发现骨质疏松、骨坏死等并发症,植骨融合良好。结论:大剂量MP连续应用能明显提高脊髓型颈椎病患者术后神经功能的恢复率;MP的上述用法是安全的,但对消化道并发症应给予关注。

The effects of Methylprednisolone on the recovery of postoperative neurological functions of cervical spondylotic myelopathy

Objective:To investigate the effects of different dosage and use of Methylprednisolone(MP)on the recovery of postoperative neurological functions of cervical spondylotic myelopathy(CSM),discuss related mech-anisms,so as to select the best way of MP for the clinic.Method:87cases of cervical spondylotic myelopathy,which underwent anteior decompression and plate fixation with follow-up results in our department during Dec.1,1999to Apr.1,2003.According to different dosage and use of MP,patients were divided into four groups,namely,group A(low-dose,postoperative):22cases.Group B(high dose,intraoperative):25cases.Group C(high-dose,postoperative):24cases.Group D(vacuity,postoperative):16cases.Comparison of short-term(1week)and long-term(half year)neurological function recovery rates by JOA scores was observed.Long-term outcomes of ODOM grading system were also analysed.Result:The factors of affecting postoperative neurological functions of CSM were analysed statisticaly.There were no significant differences among the factors except times of course between Group B and Group C.Statistical analysis showed that,between group A and group B or group C,there was significant difference(P<0.01),group B and group C provided no significant difference(P>0.05).No wounds or lungs infection occured in four groups.1case gastrectomy stoma ulcer in group B,1case melena in group C.In each group,complications such as osteoporosis and osteonecrosis were not observed during the long-term follow-up.Fusion by bone grafting was well.Conclusion:The result shows that high-dose successive administration of MP can improve postoperative neurological functions recovery of CSM significantly.The usage of MP above-mentioned is safe,except that we should pay close attention to special case.