腰椎间孔镜术后应用甲基强的松龙的作用与风险研究
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摘要
目的:观察腰椎间孔镜术后静滴甲基强的松龙对保护脊髓功能,促进术后神经功能恢复的作用及其对其它并发症的影响。方法:按前瞻性随机对照方法将100例腰椎间孔镜术病例随机分为两组,A组在腰椎间孔镜术后6h内1次,术后第1,2天每日2次静滴甲基强的松龙,每次40mg,B组术后不静滴甲基强的松龙。对术后第1、2、7、14、30、90天VAS疼痛评分、ODI评分及术后并发症等进行比较。结果:因失访、需要其它治疗等其它原因14例被排除,其余86例病人中A组46例,B组40例。术后第1、2、7天VAS疼痛评分:A组(16.00±2.83)分,(15.33±2.73)分,(14.33±2.34)分;B组:(3.67±0.82)分,(3.33±0.52)分,(2.83±0.98)分;2组比较差异有统计学意义(P<0.05)。ODI评分:A组:(16.00±2.83)分,(15.33±2.73)分,(14.33±2.34)分;B组:(25±2.10)分,(24.00±1.26)分,(23.00±1.10)分;2组比较差异有统计学意义(P<0.05)。术后第14、30、90天VAS疼痛评分、ODI评分,全身、局部并发症和预后比较差异无统计学意义(P>0.05)。结论:腰椎间孔镜术后静滴甲基强的松龙对术后围手术期内患者神经功能恢复有明显促进作用,但围手术期后恢复效果与甲基强的松龙的应用无关,同时甲基强的松龙也没有增加感染等并发症的风险。
Objective:To evaluate the efficacy and associated complications of methylprednisolone(MP)after full-endoscopic transforaminal lumbar discectomy.Methods:All 100 consecutive patients who were receiving full-endoscopic transforaminal lumbar discectomy were randomly divided into two groups.Group A received MP therapy after the operation,and group B did not receive MP.The demographics,visual analogue scale(VAS)score,Oswestry disability index(ODI)score and complications were collected.Results:Fourteen patients were excluded due to losing followed up and needed for other therapy.The VAS score was significantly higher and ODI score was significantly lower in group A(n=46)than group B(n=40)at the 1st,2nd,and 7th days after the operation(P<0.05).There were no statistically significant differences in VAS and ODI scores at the 14 th,30th,and 90 th days between the two group(P>0.05).Conclusion:The MP therapy may improve the function of nerve system during perioperative period,and may not increase the risk of complications.
Objective:To evaluate the efficacy and associated complications of methylprednisolone(MP)after full-endoscopic transforaminal lumbar discectomy.Methods:All 100 consecutive patients who were receiving full-endoscopic transforaminal lumbar discectomy were randomly divided into two groups.Group A received MP therapy after the operation,and group B did not receive MP.The demographics,visual analogue scale(VAS)score,Oswestry disability index(ODI)score and complications were collected.Results:Fourteen patients were excluded due to losing followed up and needed for other therapy.The VAS score was significantly higher and ODI score was significantly lower in group A(n=46)than group B(n=40)at the 1st,2nd,and 7th days after the operation(P<0.05).There were no statistically significant differences in VAS and ODI scores at the 14 th,30th,and 90 th days between the two group(P>0.05).Conclusion:The MP therapy may improve the function of nerve system during perioperative period,and may not increase the risk of complications.
引文
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[2]WILSON-MACDONALD J,BURT G,GRIFFIN D,et al.Epidural steroid injection for nerve root compression.A randomised,controlled trial[J].J Bone Joint Surg Br,2005,87(3):352-355.
[3]SMITH N,MASTERS J,JENSEN C,et al.Systematic review of microendoscopic discectomy for lumbar disc herniation.European spine journal:official publication of the European Spine Society,the European Spinal Deformity Society[J].Eur Spine J,2013,22(11):2458-2465.
[4]RUETTEN S,KOMP M,MERK H,et al.Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique:a prospective,randomized,controlled study[J].Spine(phila pa 1976),2008,33(9):931-939.
[5]YEUNG A T,YEUNG C A.Advances in endoscopic disc and spine surgery:foraminal approach[J].Surg Technol Int,2003,11:255-263.
[6]DEBI R,HALPERIN N,MIROVSKY Y.Local application of steroids following lumbar discectomy[J].J Spinal Disorders Tech,2002,15(4):273-276.
[7]RABINOVITCH D L,PELIOWSKI A,FURLAN A D.Influence of lumbar epidural injection volume on pain relief for radicular leg pain and/or low back pain[J].Spine J,2009,9(6):509-517.
[8]ABDI S,DATTA S,TRESCOT A M,et al.Epidural steroids in the management of chronic spinal pain:a systematic review[J].Pain physician,2007,10(1):185-212.
[9]CELIK F,GOCMEZ C,KAMASAK K,et al.The comparison of neuroprotective effects of intrathecal dexmedetomidine and metilprednisolone in spinal cord injury[J].Int J Surg,2013,11(5):414-418