大剂量甲基强的松龙在高龄脊髓型颈椎病人围手术期应用效果观察_临床医学论文.docVIP

大剂量甲基强的松龙在高龄脊髓型颈椎病人围手术期应用效果观察_临床医学论文 大剂量甲基强的松龙在高龄脊髓型颈椎病人围手术期应用效果观察_临床医学论文 作者：张小钰，陈德胜，金群华 【摘要】 ：目的 探讨高龄脊髓型颈椎病(CSM)病人在围手术期应用大剂量甲基强的松龙(MP)的疗效。方法 收集我院2000年9月－2004年10月颈椎后路单开门椎板成形术治疗65 岁以上脊髓型颈椎病80例，分为两组：A 组35例采用围手术期常规治疗，依据JOA评分标准分轻中重度分别为9例、11例和15例；B组45例围手术期给予大剂量（30mg/kg）MP治疗，轻中重度分别为13例、17例和15例，术后疗效评价依据日本骨科学会的评定标准。结果 两组术前颈脊髓压迫程度轻，术后其功能和形态恢复明显，且B组患者术后颈脊髓形态和功能较A组明显改善（P＜0.05）。结论 围手术期使用大剂量MP可以提高高龄脊髓型颈椎病病人术后的疗效。 【关键词】 脊髓型颈椎病；甲基强的松龙； 围手术期 　　Abstract：Objective To discuss the curative of high dose of methylprednisolone in the aged patients with cervical spondylotic myelopathy during the period of pre-op and post-op. Methods 80 patients over 65 years old with cervical spondylotic myelopathy were retrospectively analyzed who applid posterior cervical spine canal open-door laminoplasty between September 2000 to October 2004 in group A(n=35)， patients were grading in mild(9cases)、moderate (11cases) and severe(15cases) degree by system of Japanese Orthopedic Association (JOA) ， therapied routinedly; in group B(n=45)， there were mild(13cases)，moderate (17cases) and severe(15cases) degree by JOA， all the patients giving high dose (30mg/kg) of methylprednisolone period of pre-op and post-op， the results of operation were evaluated by JOA.Results Effectiveness in experimental group were significantly better than that in control group(P＜0.01). The more severe cervical spinal cord oppressed preoperatively， the worse improved postoperatively. Conclusion The use of high dose of methylprednisolone on the cervical spondylotic myelopathy patients who were in advanced age during the period of pre-op and post-op the symptoms can significantly improve effectiveness. 　　Key words：CSM; MP; period of pre-op and post-op 　　脊髓型颈椎病(cervical spondylotic myelopathy，CSM)以颈椎退变为基础，导致脊髓受压迫及脊髓缺血改变。CSM应早期施行手术治疗，围手术期应用大剂量(30mg/kg)甲基强的松龙(methylprednisolone，MP)能改善术后效果［1］，但对于老年患者的效果尚未见报道。本研究选自2000 年9 月－2004 年10 月采用颈椎后路单开门椎板成形术治疗65 岁以上脊髓型颈椎病80例，现将围手术期给予大剂量甲基强的松龙对术后随访疗效的观察报告如下。 　　1 临床资料 　　1. 1 一般资料 　　本组男49例，女31例，年龄65～7