腰椎管狭窄症手术中应用大剂量甲基强的松龙对神经的保护作用

High Dosage Methylprednisolone for Neural Protection in Operation for Lumbar Spinal Stenosis

目的探讨腰椎管狭窄症手术治疗中大剂量甲基强的松龙(MP)对脊髓的保护作用。方法腰椎管狭窄症患者20例,均采用单纯后路腰椎板切除术。治疗组11例,于切开皮肤时静脉给予MP30mg/kg;术后静脉应用MP40mg/次,2次/d,共3d。对照组9例,术中不使用MP,术后静脉给予MP40mg/次,2次/d,共3d。应用JOA评分评价两组患者术前和术后神经功能情况。结果治疗组及对照组术前JOA评分分别为(9.25±2.12)分和(9.53±2.10)分(P>0.05)。术后1周时治疗组与对照组JOA评分分别为(13.43±2.01)分和(11.21±2.13)分;3个月时JOA评分分别为(14.62±2.15)分和(13.04±2.11),治疗组均优于对照组(P<0.05)。对照组出现神经症状加重患者1例。两组患者均未出现消化性溃疡、切口愈合不良等并发症。结论腰椎管狭窄症术中应用大剂量甲基强的松龙对脊髓神经功能有明显保护作用。

Objective To observe the protective effect of high-dosage methylprednisolone（MP）after lumbar spinal stenosis operation.Methods20 Patients with lumbar spinal stenosis accepted laminectomy.The treatment group（11 cases）received MP 30 mg/kg when the skin incised,and followed with MP 40 mg twice a day for 3 d after operation.The control group（9 cases）received MP 40 mg twice a day for 3 d after operation.They were assessed with JOA scale before and after operation.ResultsThe JOA score was（9.25±2.12）and（9.53±2.10）in treatment group and control group before operation（P〈0.05）,and was（13.43±2.01）and（11.21±2.13）1 week after operation（P〈0.05）,（14.62±2.15）and（13.04±2.11）3 months after operation（P〈0.05）.The neurological symptom deteriorated in 1 cases of control group.No peptic ulcer,poor wound healing or other associated complications has been found.ConclusionHigh-dosage methylprednisolone may protect the spine cord intraoperative the lumbar spinal stenosis.