神经根周围应用甲基强的松龙对腰椎间盘切除术疗效的影响

Local application of methylprednisolone around the nerve roots in lumbar discectomy

目的:探讨腰椎间盘切除术中在减压后的神经根周围应用甲基强的松龙(MP)对患者术后神经根性痛和神经功能改善的影响。方法:76例腰椎间盘突出症患者行小切口单纯髓核切除术,其中36例髓核切除后在减压的神经根周围以甲基强的松龙80mg浸润的明胶海绵覆盖(治疗组),另40例行同样手术,但在减压的神经根周围以生理盐水浸润的明胶海绵覆盖(对照组)。术前和术后6h、1d、3d、1周采用VAS法进行疼痛评分,术前和术后3个月采用JOA评分评估患者神经功能恢复情况。结果:治疗组患者在术后1周内的神经根性疼痛程度明显低于对照组(P<0.01或P<0.05);术后3个月治疗组JOA评分略高于对照组,但无显著性差异(P>0.05)。结论:腰椎间盘切除手术时在神经根周围给予甲基强的松龙可明显减轻腰椎间盘突出症患者术后神经根性疼痛,但对患者神经功能恢复的影响不显著。

Objective：To evaluate short term outcome of local application of methylprednisolone （MP） around the decompressed nerve root in lumbar discectomy.Method：Seventy six cases of lumbar discectomy were selected for the study,36 cases were chosen randomly as study group,40 cases as control group.In study group, a gelfoam soaked in 80mg MP was implanted on the surface of the decompressed nerve root after discectomy. Gelfoam used in the control group was soaked in saline.VAS pain scale was used to record the degree of the patinets＇ sciatica before the operation,6 hours,1 day,3 days and 7 days after the operation.JOA score was used to evaluate the patients＇ outcome in 3 months postoperativly.Result：The patients in the study group got significant pain relief within the first week after the operation,compared with the control group P〈0.01 or P〈 0.05,and a better JOA outcome in 3 months follow-up after operation,but no significant difference （P〉0.05）. Conclusion：Local use of MP around the nerve root after discectomy can significantly relieve the pain in the first week after operation,but doesn＇t affect patient＇s functional recovery in the short term.