甲基强的松龙在颈椎后纵韧带骨化症围手术期应用的疗效

目的探讨甲基强的松龙(MP)在颈椎后纵韧带骨化症患者围手术期应用的效果。方法选择2004年1月至2007年1月在我院脊柱外科手术治疗的76例颈椎后纵韧带骨化症患者,其中49例行前路减压术,27例行后路减压术。根据围手术期用药情况将其分为2组,MP组38例,在脊髓减压前30min予MP1000mg,iv gtt,术后d 1、2、3给予MP 160 mg,30 min内iv gtt;地塞米松(Dex)组38例,术后d 1、2、3应用地塞米松20mg·d~(-1),iv gtt,d4减至10mg,d 5减至5mg,5 d后停用。应用美国脊髓损伤协会(ASIA)评分评价2组患者术前和术后神经功能情况。结果2组患者术后7d和3mo的评分均较术前明显提高(P<0.05);但MP组术后7d和3mo神经功能均优于Dex组(P<0.05)。Dex组2例患者术后出现一过性神经症状加重。2组均未出现消化道出血、切口感染等并发症。结论外科减压治疗颈椎后纵韧带骨化症是改善脊髓神经功能的有效方式,同时应用MP可有效维持减压后获得改善的脊髓神经功能。

Effects of methylprednisolone on perioperation neurological functions of patients undergoing cervical ossified posterior longitudinal ligament surgery

AIM To evaluate the effect of methylpredniselone (MP)on perioperative neurological functions of cervical ossified posterior longitudinal ligament.METHODS From January 2004 to January 2007,76 cases of cervical ossified posterior longitudinal ligament (OPLL)who underwent surgical operation were enrolled,among which,49 cases were operated anteriorly,and 27 cases posteriorly.According to MP using or not,all the cases were divided into 2 groups:group A,n = 38,1 000 mg MP(intravenously),30 min before decompression,and 80 mg MP(intravenously), bid for 3 d;group B,n = 38,10 rng dexamethasone (intravenously),bid for 3 d,5 mg,bid for the fourth day,and 5 mg,qd for the fifth day postoperatively.The patients' neurological functions were graded preoperatively and in 1 wk and 3 mo postoperatively according to the American Spinal Injury Association (ASIA)score system.Complications were recorded during the observation time.RESULTS Preoperative ASIA scores among groups were of no statistical difference (P>0.05);postoperative ASIA scores were higher than those preoperative in each group,and postoperative ASIA scores in group A treated with MP were higher than in group B treated with dexamethasone (P<0.05).No incision in- fection,and alimentary tract hemorrhage were observed in both the 2 groups,while 2 cases in group B had a transient neu- ral function worsening.CONCLUSION Surgical depression is a useful method for cervical ossified posterior longitudinal ligament syndrome in improving neurological function.Perioperative intravenous application of MP can significantly main- tain the improved short-term postoperative neurological function.