腰椎管狭窄症围手术期甲强龙的神经保护作用研究

目的研究甲基强的松龙在腰椎管狭窄症围手术期对神经根牵拉损伤的保护作用。方法腰椎管狭窄症患者66例,分为两组。A组为对照组共32例;B组为甲强龙治疗组共34例。术前及术后1周、3个月分别采用JOA下腰痛评分系统对两组病人进行评分并比较。结果A组术后出现根性刺激症状者7例,B组1例。术后一周两组JOA评分有显著性差异（p〈0.01）;术后3月则无显著性差异。结论甲强龙可以改善腰椎管狭窄症术后的神经根刺激症状,而其远期疗效则与对照组无异。

Preoperative application of methylprednisolone for lumbar spinal stenosis

Objective To study the prophylactic effects of high dose methylprednisolone（MP） for preoperative surgical treatment of lumbar spinal stenosis.Method From Ferb 2005 to Jun 2008,a retrospective study of 66 patients who underwent posterior lumbar vertebral canal decompression was made.The patients were divided into 2 groups according to the application of MP or DX at preoperational.34 patients in MP group were treated with MP stoss（30mg/kg,iv 15 min） 30 min prior to the decompression and then MP（80mg/d） was continued for the following 3 days.32 patients in the DX group were treated with dexamethasone（DX） 10 mg 30 min prior to the decompression and then DX（10 mg/d,iv） was given for 3 days after operation.Neurological function improvement rates were evaluated according to the JOA scores（postoperative JOA scores-preoperative JOA scores/29 preoperative JOA scores）×100% at 3rd day,7th day,3rd month and 6th month after operation.Complication were observed.Result Neurological function recovery rates were 23.23±2.01% in MP group and 8.12±1.10% in the control group at 3 days after operation.The difference was found to be significant（p〈 0.05）.Neurological function recovery rates were 26.69±2.97% in MP group and 16.47 ±2.15% in the control group at 7 days after operation.The difference was found to be significant（p 〈0.05）.There was no significant difference in neurological function recovery rates between the two groups at 3 and 12 months（p 〉0.05）.Neurological deficit was found in 5 in control group,while no one in the MP group.Conclusion High dose of MP used preoperatively for lumbar stenosis can protect spinal cord and improve operative security,while it does not increase serious adverse complications.