摘要
目的探讨单唾液酸四己糖神经节苷脂（monalsialic acid four hexose ganglioside sodium，GM-1）静脉注射联合鞘内注射对颈脊髓不完全性损伤术后患者的临床效果。方法2011年1月至2015年1月我们收治79例伴有难复位性关节突交锁的颈椎骨折脱位合并颈脊髓损伤患者，均进行一期前后路联合手术治疗，术后常规使用抗生素预防感染，并给予激素、脱水、促进骨细胞生长、营养神经等药物治疗。应用计算机随机分组，静脉注射组42例于术后给予GM-1 40 mg/d静脉注射，出院后改为甲钴胺片0.5 mg/次，3次/d，口服30 d；联合鞘内注射组37例，术后给予GM-1 40 mg/d，静脉注射15 d，出院后每周鞘内注射1次，40 mg，共4周。脊髓损伤程度按照Frankel分级评估；颈椎功能按照JOA评分评估；影像学评价植骨融合、颈椎稳定性和脊髓损伤程度。结果静脉注射组与联合鞘内注射组的手术时间分别为（4.15±0.65） h和（4.10±0.85） h，术中出血量分别为（850.50±35.10） ml和（858.60±25.20） ml，两组比较差异均无统计学意义（t值分别为1.375、1.452，P均〉0.05）。联合鞘内注射组GM-1的用药总量为（785.20±3.28） mg，明显高于静脉注射组[（610.55±5.28） mg]，差异有统计学意义（t＝12.542，P〈0.05）；79例患者获得12.0～24.0个月随访，平均（15.2±1.3）个月。术后末次随访时联合鞘内注射组的神经功能改善率为（64.35±4.33）%，明显高于静脉注射组[（55.50±5.44）%]，差异有统计学意义（t＝8.813，P〈0.05）；两组术后12个月JOA评分分别为（13.55±1.75）分和（12.85±1.97）分，均明显优于术前[（7.25±0.83）分和（7.19±0.93）分]，差异均有统计学意义（P均〈0.05）；术前和术后两组间的日本骨科学会评分比较差异均无统计学意义（P均〉0.05）。末次随访时X线提示植骨处均获得骨性融合、内固定位置良好、牢固；MR提示颈�
ObjectiveTo investigate the clinical effect on incomplete spinal injury by ganglioside intravenous injection combined with intrathecal injection.MethodsFrom January 2011 to January 2015, seventy-nine cases with irreducible articular process interlocking of cervical spine fracture with dislocation of cervical spinal cord injury, underwent one stage anterior and posterior surgical treatment, postoperative routine use of antibiotics to prevent infection, and the hormone, dehydration to promote bone cell growth and neurotrophic drugs treatment.The patients were randomly divided into the intravenous injection group （42 cases）, given intravenous injection of monalsialic acid four hexose ganglioside sodium（GM-1） 40 mg/d, mecobalamin tablets 0.5 mg/time, 3 times/d, 30 d oral; the combined intrathecal injection group （37 cases） was given GM-1 40 mg/d, intravenous injection at 15 d after intrathecal injection, 1 time a week 40 mg, with a total of 4 weeks.The degree of spinal cord injury was evaluated according to Frankel classification; cervical function was evaluated according to JOA score; bone graft fusion, stability of cervical spine and degree of spinal cord injury were evaluated by imaging.
ResultsThe operation time in the intravenous injection group and the combined intrathecal injection group were （4.15±0.65） h and （4.10±0.85） h, and the intraoperative blood loss was （850.50±35.10） ml and （858.60±25.20） ml, respectively, and there were no significant differences between the two groups （t=1.375, 1.452, P〉0.05）. The total dose of GM-1 in the combined intrathecal injection group was （785.20±3.28） mg, significantly higher than that in the intravenous injection group （（610.55±5.28） mg）, the difference was statistically significant （t=12.542, P〈0.05）; 79 patients were followed up for 12-24 months, with an average of （15.2±1.3）months.The improvement rate of nerve function of the combined intrathecal injection group was（64.35±4.33）%, significantly higher
出处
《中国综合临床》
2018年第1期54-58,共5页
Clinical Medicine of China
关键词
脊髓损伤
神经节苷脂
关节突交锁
颈椎
静脉注射
鞘内注射
Spinal cord injury
Gangliosides
Articular process interlocking
Cervical spine
Intravenous injection
Intrathecal injection
