甲基强的松龙冲击疗法对手术治疗脊髓型颈椎病近期疗效的影响

High-dose of methylprednisolone in the surgical treatment of cervical spondylotic myelopathy in early stage

目的:探讨术中应用大剂量甲基强的松龙(MP)对严重脊髓型颈椎病患者脊髓减压术后近期神经功能恢复的影响。方法:2001年6月至2004年12月行前路减压植骨内固定的中重度脊髓型颈椎病患者124例,影像图片证实脊髓横断受压面积≥25%。根据术中是否使用MP分为两组:MP组60例,术中脊髓减压前30min左右给予MP20mg/kg快速静滴,术后20%甘露醇250ml静滴,连续维持3d;对照组64例,术中脊髓减压前30min左右给予地塞米松20mg快速静滴,术后给予20%甘露醇250ml+地塞米松10mg静滴,每日1次,维持3d。观察患者术后1周内脊髓功能恢复情况,按JOA脊髓功能评分标准评定神经功能恢复率,并统计其并发症。结果:术后第1天和第3天MP组神经功能恢复率稍好,但两组差异无显著性(P>0.05);术后第7天,MP组和对照组脊髓神经功能恢复率分别为75.50%±6.18%和61.02%±6.30%,两组存在显著性差异(P<0.05)。两组与糖皮质激素相关的并发症无差异。结论:对严重脊髓型颈椎病患者术中脊髓减压前应用大剂量MP冲击治疗能明显提高患者术后近期神经功能恢复率,且不增加与糖皮质激素相关并发症的发生。

Objective：To investigate the effects of high-dose of methylprednisolone（MP） on the recovery of postoperative neurological functions due to cervical spondylotic myelopathy in early stage.Method：124 patients with cervical spondylotic myelopathy were treated with anterior decompression and fusion with autogeneous graft and plate fixation in our department.The candidate were the compressed area of spinal cord in transect≥25%.According to use of MP in the surgery or not,the patients were divided into the MP and the control group.60 cases were treated with MP（20mg/kg,iv） 30min prior to the decompression and then followed by 20% mannitol 250ml（iv,qdx3d） in the MP group.64 cases were treated with DXM 20mg 30min prior to the decompression and then 20% mannitol 250ml＋DXM 10mg（iv,qdx3d） after operation in the control group.Early-stage （1 week） postoperative neurological function recovery rate were evaluated by the JOA scores.And complications of both groups were recorded.Result：Statistical analysis showed that there were no significant difference in the neurological function recovery rate between the two groups on the first or third day postoperatively （P〉0.05）. While compared with the control group,significant improvement of neurological function were found in the MP group on the 7th day after operation （P〈0.05）.No side-effect brought about by glucocorticoid occurred in the two groups.Conclusion：High-dose administration of MP just before the decompression surgery in patients with cervical spondylotic myelopathy can improve postoperative neurological function recovery rate significantly in early stage and the adminstration of MP mentioned above is safe.