甲泼尼龙联合注射用鼠神经生长因子治疗急性脊髓及马尾神经损伤的临床应用

CLINICAL EFFECT OF METHYLPREDNISOLONE SODIUM SUCCINATE AND MOUSE NERVE GROWTH FACTOR FOR INJECTION IN TREATING ACUTE SPINAL CORD INJURY AND CAUDA EQUINA INJURY

目的探讨甲泼尼龙[注射用甲泼尼龙琥珀酸钠(methylprednisolone sodium succinate,MPSS),简称MP]联合注射用鼠神经生长因子(mouse nerve growth factor,mNGF)对急性脊髓损伤(acute spinal cord injury,ASCI)及马尾神经损伤患者的应用价值。方法回顾性分析2004年12月-2007年12月手术治疗的43例ASCI及马尾神经损伤患者临床资料,其中男33例,女10例;年龄32～66岁,平均43岁。损伤部位:C21例,C45例,C57例,C63例,T81例,T101例,T112例,T123例,L19例,L25例,L33例,L41例,L52例。入院时有感觉、运动功能障碍;神经功能按Frankel分级:A级5例,B级12例,C级22例,D级4例。将43例随机分为2组,A组(23例)为MP联合注射用mNGF组,B组(20例)为单纯使用MP组。两组一般资料比较差异无统计学意义(P>0.05),具有可比性。患者均于伤后8h内入院并接受药物治疗,48h内给予椎管减压、椎间植骨加内固定手术。治疗前、治疗后1周及2年按美国脊髓损伤学会(ASIA)标准行神经功能评分,计算神经功能改善率,并行日常生活活动(activity of daily living,ADL)评分比较。结果患者手术切口均Ⅰ期愈合。43例均获随访,随访时间24～61个月,平均30个月。术后6～17个月,平均11个月植骨融合,内固定稳定。无患者死亡及骨坏死、向心性肥胖等并发症发生。治疗后1周及2年两组神经功能评分及ADL评分均显著高于治疗前评分(P<0.01)。治疗前两组间各评分比较差异均无统计学意义(P>0.05),治疗后1周及2年A组各评分均优于B组(P<0.01)。治疗后1周及2年A组的神经功能改善率分别为47.8%(11/23)和91.3%(21/23),均优于B组的30.0%(6/20)和70.0%(14/20),差异有统计学意义(P<0.01)。结论 MP联合注射用mNGF治疗ASCI及马尾神经损伤可促进神经功能的恢复。

Objective To investigate the effect of methylprednisolone sodium succinate （MP） and mouse nerve growth factor （mNGF） for injection in treating acute spinal cord injury （ASCI） and cauda equina injury. Methods Between December 2004 and December 2007, 43 patients with ASCI and cauda equina injury were treated, including 33 males and 10 females with an average age of 43 years （range, 32-66 years）. Injured vertebral columns were C2 in 1 case, C4 in 5 cases, C5 in 7 cases, C6 in 3 cases, T8 in 1 case, T10 in 1 case, T11 in 2 cases, T12 in 3 cases, L1 in 9 cases, L2 in 5 cases, L3 in 3 cases, L4 in 1 case, and L5 in 2 cases. All the patients had sensory disturbance and motor dysfunction at admission. The Frankel scale was used for assessment of nerve function, 5 cases were rated as Grade A, 12 as Grade B, 22 as Grade C, and 4 as Grade D before operation. In 43 patients, 23 cases were treated with MP and mNGF （group A）, 20 cases with MP only （group B）. There was no significant difference in general data between 2 groups （P 〉 0.05）. All the patients were admitted, received drug treatment within 8 hours of injury, and were given spinal canal decompression, bone transplantation, and internal fixation within 48 hours. The neurological function score systems of American Spinal Injury Association （ASIA） were used for neurological scores before treament, at 1 week and 2 years after treatment. The scores of the activity of daily living （ADL） were evaluated and compared. Results All the patients achieved healing of incision by first intention. Forty-three cases were followed up 24-61 months with an average of 30 months. Bone graft fusion was achieved after 6-17 months, 11 months on average with stable fixation. No death and complications of osteonecrosis and central obesity occurred. There was no significant difference in neurological function scores and ADL scores between 2 groups before treatment （P 〉 0.05）; however, the neurological function scores and ADL scores at 1 week and 2 years after treatment were higher than those before treatment （P 〈 0.01） in 2 groups. Group A had higher neurological function scores and ADL scores than group B （P 〈 0.01）. At 1 week and 2 years after treatment, the improvement rates of neurological function of group A （47.8%, 11/23 and 91.3%, 21/23） were significantly higher （P 〈 0.01） than those of group B （30.0%, 6/20 and 70.0%, 14/20）. Condusion MP and mNGF play an important role in improving the neurological function in patients with ASCI and cauda equina injury.