甲泼尼龙在胸椎管狭窄症治疗中的应用

Clinical application of methylprednisolone on recovery of thoracic spinal stenosis symptom

目的：探讨甲泼尼龙在胸椎管狭窄症治疗中的作用。方法：对82例胸椎管狭窄症患者采用单纯后路胸椎板切除术。8例患者于减压后的2—4h突然出现类似于脊髓休克症状，除外机械性压迫因素，临床上考虑为脊髓缺血再灌注损伤。所有患者减压前30min给予甲泼尼龙1000mg冲击，77例减压术后给予逐日减量治疗，其中脊髓缺血再灌注损伤3例；其余5例缺血再灌注损伤患者给予甲泼尼龙冲击和维持量治疗。结果：无围手术期死亡，1例发生应激性溃疡。甲泼尼龙逐日减量治疗组中74例术后呈现程度不同的恢复；3例术后出现缺血再灌注损伤患者神经功能恢复较慢且未恢复至正常，经过1年随访，1例恢复至正常，2例仍无明显恢复。5例甲泼尼龙冲击和维持量治疗组中4例患者神经功能明显恢复，1例恢复较慢，经过1年随访，均基本恢复至正常。结论：甲泼尼龙在胸椎管狭窄症的治疗中对减轻脊髓水肿、抑制血管活性物质、稳定细胞膜等环节起显著作用。

Objective：To investigate the effect of methylprednisolone on thoracic spinal stenosis symptom. Methods： 82 patients adopt of simply posterior thoracic vertebral canal decompression. 8 cases occurred acute spinal shock symptom after 2 -4 h surgical decompression. Considering this kind of symptom is spinal cord ischemic reperfusion （IR） injury. All cases infusion methylprednisolone 1 000 mg before decompression in 30 min. After operation, 77 cases were infused methylprednisolone extenuation day by day and 3 cases were spinal cord IR injury; 5 cases of spinal cord IR injury were treated with stoss and maintenance dose of methylprednisolone therapy. Results： No death was noted, and 1 case occurred stress ulcer. Among cases treated with methylprednisolone extenuation therapy, 74 cases recovered well; 3 cases of spinal cord IR injury motor function recovered slowly. After 1 year follow-up, 1 case completely recovered and the other 2 cases were not well. 5 cases treated with stoss and maintenance dose of methylprednisolone therapy, 4 cases motor function remarkably recovered, 1 case recovered slowly. After 1 year follow-up, 5 cases completely recovered. Conclusion：Methylprednisolone has significantly effect on treatment of thoracic stenosis symptom in extenuation spinal cord swelling, inhibit vasoactive substance, stabilize cellular and lysosomal membrane.