医学资料甲基强的松龙在脊柱非创伤性疾病治疗中的应用

1、会计学1医学资料甲基强的松龙在脊柱非创伤性医学资料甲基强的松龙在脊柱非创伤性疾病治疗中的应用疾病治疗中的应用1、减轻脊髓和神经根细胞膜水肿2、抑制神经细胞膜和轴突、树突的脂质过氧化进程3、抑制一般性炎症反应和作用1.Relieving edema of cell membranes of spinal cord and nerve roots2.Inhibiting lipid peroxidation of nerve cell membrane, axons and dendrites 3.Suppressing general inflammatory reaction4、间接改善局部血

2、液循环5、抑制细胞的凋亡6、减轻再灌注损伤4. Indirectly improving local blood circulation5. Inhibiting apoptosis6. Relieving reperfusion injury 碎骨片Small piece of bone graft小关节交锁Locked facet joint椎间盘碎片Disc fragment后路切开复位，经椎弓根螺钉内固定Posterior approach for ORIF and trans-pedicle screw fixation前路椎间盘切除、植骨、内固定Anterior ACDF and

3、plating脊髓型颈椎病，发育性颈椎管狭窄,C4-5椎间盘突出Cervical spondylotic myelopathy, Developmental cervical Spinal stenosis,C4-5 disc protrusion后路C3-7椎管成形术+前路C4-5椎间盘切除+CAGE植入Posterior C3-7 laminoplasty+ Anterior C4-5 discectomy + CAGE implantation颈椎管内肿瘤，压迫脊髓Cervical intraspinal tumor, compressed spinal cord颈椎后纵韧带骨化，脊髓严

4、重受压,单开门术后Ossification of posterior longitudinal ligament of cervical spine,severely compressed spinal cord，post-open door laminoplasty颈椎结核，椎管内脓肿Tuberculosis of cervical spine, intraspinal abscess颈椎椎板切除术后后凸畸形Post-laminectomy cervical Kyphosis 颈椎前路松解+后路松解+前后路固定、矫正、融合Combined anterior and posterior rel

5、ease, fixation, correction and fusion Eur-Spine-J 2003 12(1) 84-90Eur-Spine-J 2003 12(1) 84-90Eur-Spine-J 2003 12(1) 84-90* Peoples Liberation Army 术后神经功能评分恢复率 A组组 B组组 C组组 D组组 近期（近期（1 1周）周）39.739.713.6 53.813.6 53.814.6 56.614.6 56.615.3 41.715.3 41.716.616.6 远期远期( ( 半年半年) 51.4) 51.414.4 74.814.4 74

6、.816.2 76.816.2 76.814.8 53.114.8 53.118.218.2 B组和C组术后神经功能的改善明显优于A组及D组 Mechanical and chemical stimulation of outer layers of annulus fibrosus and sinuovertebral nerve in posterior longitudinal ligament by protruded nucleus pulposus beck painMechanical and chemical stimulation of nerve roots by prot

7、ruded nucleus pulposus and its inflammatory reactionsciatica突出的髓核对纤维环外层及后纵韧带上的窦椎神经的机械性、化学性刺激腰痛突出的髓核及其引起的炎症反应对神经根的机械性、化学性刺激坐骨神经痛Inclusion Criteria 入选标准入选标准Acute episodeSingle level protrusionInefficiency of 6 weeks conservative therapy Having operation within 6 months after episodeFinal diagnosis dep

8、endent on CT and MRI scan急性发作单一节段间盘突出保守治疗6周无效发作后6个月内接受手术治疗确诊依赖CT及MRI检查手术方法：单侧椎板间开窗，髓核摘除 Surgical procedures: Single level laminotomy, removal of nucleus pulposusJ Neurosurg. 1993 Mar;78(3):383-7.剔除病例剔除病例Exclusion Criteria 病史超过6个月 多节段间盘突出 椎管狭窄 症状与影像学表现不符 有过椎管内手术史More than 6 months history Multiplelev

9、el protrusion Stenosis of spinal canal Symptoms not consistent with image manifestation Having history of intraspinal operation手术方法：单侧椎板间开窗，髓核摘除 Surgical procedures: Single level laminotomy, removal of nucleus pulposusJ Neurosurg. 1993 Mar;78(3):383-7.手术开始时At the beginning of operation 手术结束时At the e

10、nd of operation第一组Group 1250mg MP 静脉注射160mg MPA 肌肉注射 30ml0.25% 普鲁卡因皮下及肌肉注射250mg MP IV160mg MPA IM 30ml 0.25% procaine subcutaneous injection and IM30ml0.25% 普鲁卡因皮下及肌肉注射浸泡有80mgMPA的脂肪覆盖神经根30ml 0.25% procaine subcutaneous injection and IMFat marinated with 80mg MPA covering nerve roots 第二组Group 230ml0.

11、25% 普鲁卡因皮下及肌肉注射30ml 0.25% procaine subcutaneous injection and IM30ml0.25% 普鲁卡因皮下及肌肉注射30ml 0.25% procaine subcutaneous injection and IM第三组Group 310ml0.5%利多卡因皮下及肌肉注射10ml 0.5% procaine subcutaneous injection and IMJ Neurosurg. 1993 Mar;78(3):383-7Complete remission of nerve root pain after operation012

12、34567891 day 1 week 1 month Group 1Group 2Group 3J Neurosurg. 1993 Mar;78(3):383-7.术后时间Time of Post-OPMP methylprednisolone; DX dexamethasoneMP methylprednisolone; DX dexamethasone大剂量MP在脊柱手术后的应用Use of High-dose MP After Spinal SurgeryMP methylprednisolone; DX dexamethasone脊柱侧弯Scoliosis脊柱滑脱Spondylolisthesis腰间盘突出Lumbar disc protrusion腰椎管狭窄Stenosis of lumbar spineMP组MP group021613DX 组DX group161211病例资料：Cases：陈旸 颈腰痛杂志2003年第24卷第1期35-36Chen Yang, 2003大剂量MP在脊柱手术后的应用Use of High-dose MP After Spinal Surgery大剂量MP在脊柱手术后的应用Use of High-dose MP After Spinal Surgery颈椎后纵韧带骨化，脊髓严重受压,单开门术后Ossification of