设为首页 |  加入收藏 |  联系我们

如:神经外科 骨科 手外科 眼科 神经内科……

鼠神经生长因子联合甲钴胺治疗未行激素冲击治疗的急性不完全性脊髓损伤

发布日期:2016-07-19 点击次数:1492 字体显示:【大】  【中】  【小】

鼠神经生长因子联合甲钴胺治疗未行激素冲击治疗的急性不完全性脊髓损伤

【作者】 林红; 李超; 姜允琦; 马易群; 李熙雷; 周晓岗; 董健

【作者单位】 复旦大学附属中山医院骨科, 上海,200032

【摘要】 目的 探讨鼠神经生长因子(mNGF)联合甲钴胺在对未行激素冲击治疗的急性胸腰椎骨折合并不完全性脊髓损伤(ISCI)患者中的应用价值.方法 对2007年10月至2010年9月伤后8h未进行激素冲击治疗的急性胸腰椎骨折合并ISCI的56例患者资料进行回顾性分析,按照术后处理方法不同分为2组:mNGF联合甲钻胺组(联合组,28例)和单纯使用甲钴胺组(单纯组,28例).比较术后恢复情况,比较两组患者治疗前、治疗后1周、8周及12个月美国脊髓损伤协会(ASIA)标准的神经功能评分、日常生活活动(ADL)评分及神经功能改善率. 结果 所有患者获12 ~48个月(平均20个月)随访,无患者死亡,无创口感染;术后平均10个月植骨获融合.治疗后1周、8周及12个月两组神经功能评分及ADL评分均明显高于治疗前,除单纯组在1周时神经功能评分差异无统计学意义(P>0.05),余差异均有统计学意义(P<0.05),且治疗后联合组各时间点评分均优于单纯组,差异有统计学意义(P<0.05).术后1周、8周及12个月联合组的神经功能改善率分别为32.1% (9/28)、82.1% (23/28)和92.9% (26/28),均优于单纯组的25.0% (7/28)、50.0% (14/28)和71.4% (20/28),其中8周和12个月差异有统计学意义(P<0.05). 结论 与单纯应用甲钻胺比较,mNGF与甲钴胺联合治疗ISCI可促进脊髓损伤的恢复,改善神经功能.

【Abstract】Objective To evaluate the clinical efficacy of mouse nerve growth factor (mNGF) plus mecobalamin in the treatment of incomplete spinal cord injury (ISCI) without high-dose methylprednisolone therapy. Methods From October 2007 to September 2010,72 ISCI patients (Frankel grades B,C & D)without previous high-dose methylprednisolone therapy were treated in our department,of whom 56 were retrospectively selected for the present study and divided into 2 groups.In group A 28 patients were treated with combination of mNGF and meeobalamin; 28 patients in group B were treated with mecobalamin only.In this series,American Spinal Injury Association (ASIA) impairment scale and Activity of Daily Living (ADL) evaluation were used to observe and calculate nerve function improvement preoperation and 1 week,8 weeks,12 months postoperation. Results The mean follow-up period was 20 months (from 12 to 48 months).No mortality or incision infection was observed.Fusions of bone graft were observed 10 months postoperation on average.The ASIA and ADL scores at 1 week,8 weeks and 12 months postoperation were significant higher than those preoperation in both groups (P <0.05) except the ASIA score 1 week postoperation in group B.The postoperative ASIA and ADL scores in Group A were all significantly higher than those in group B ( P < 0.05).The nerve function improvement at 1 week,8 weeks and 12 months postoperation in group A were 32.1% (9/28),82.1% (23/28) and 92.9% (26/28) respectively,which were better than those in group B [25.0% (7/28),50.0% (14/28) and 71.4% (20/28) ],with a significant difference at 8 weeks and 12 months postoperation ( P < 0.05 ). Conclusion Compared with administration of sole mecobalamin,combination of mNGF and mecobalamin proves to be highly effective in promoting ISCI recovery and improving nerve functiont.

【关键词】 脊髓损伤; 鼠; 神经生长因子; 甲钴胺; 神经功能;

【Keywords】Spinal cord injury;  Mouse;   Nerve growth factor;  Mecobalamin;  Nerve function

doi:10.3760/cma.j.issn.1671-7600.2012.03.006