| 陈启明,余春华,许汉荣,任伟峰,季烈峰,朱仰义,沈则民,陈其昕.小剂量甲基强的松龙联合补阳还五汤治疗无骨折脱位型颈脊髓损伤的临床疗效观察[J].浙江中西医结合杂志,2022,32(12): |
| 小剂量甲基强的松龙联合补阳还五汤治疗无骨折脱位型颈脊髓损伤的临床疗效观察 |
| Clinical observation of low-dose methylprednisolone combined with Buyanghuanwu decoction in the treatment of cervical spinal cord injury without fracture or dislocation |
| 投稿时间：2021-11-29 修订日期：2022-09-18 |
| DOI： |
| 中文关键词: 甲基强的松龙 补阳还五汤 颈椎 脊髓损伤 |
| 英文关键词:Methylprednisolone Buyanghuanwu decoction Cervical vertebrae Spinal cord injuries |
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| 中文摘要: |
| 目的：探讨小剂量甲基强的松龙联合补阳还五汤治疗无骨折脱位型颈脊髓损伤的临床疗效。方法：2018年1月至2020年1月,收治无骨折脱位型颈脊髓损伤非手术治疗患者93例,其中男57例,女36例；年龄29～82岁,平均(53. 7±11.9)岁。按随机表法分成两组,小剂量甲基强的松龙联合补阳还五汤治疗组与单纯小剂量甲基强的松龙治疗对照组,其中治疗组47例,对照组46例。比较两组患者受伤入院时和治疗1个月、3个月及末次随访的神经功能,通过日本骨科协会(JOA)17分法对所有患者神经功能进行评分,计算神经功能改善率,同时根据颈椎功能障碍指数量表(NDI)对患者颈椎功能改善情况进行评定。结果：所有患者均获得随访,时间12~24个月,平均15.9个月。治疗组入院时JOA评分及颈椎功能障碍指数(NDI)分别为10.25±3.43、28.13±4.52,治疗后1个月分别为13.08±2.52、17.67±4.15,治疗后3个月分别为14.38±3.36、12.53±3.59,末次随访分别为15.01±2.58、9.87±2.76；对照组入院时JOA评分及颈椎功能障碍指数(NDI)分别为10.29±3.12、27.81±5.78,治疗后1个月分别为12.11±2.35、19.39±3.83,治疗后3个月分别为13.05±3.07、15.91±4.75,末次随访分别为14.86±2.27、10.36±3.07。两组患者末次随访颈椎功能障碍指数(NDI)及JOA评分均较受伤入院时明显提高(P＜0.05),虽然末次随访时两组评分差异无统计学意义(P＞0.05),但治疗后1个月、3个月复查随访时,治疗组较对照组脊髓功能改善更为明显(P＜0.05),JOA评分的改善率对照组为(68.29±10.15)%,治疗组为(69.11±11.73)%,两组差异无统计学意义(P＞0.05)。结论：小剂量甲基强的松龙联合补阳还五汤治疗无骨折脱位型颈脊髓损伤,结合中医辨证施治和整体观念的优势,更有利于减轻继发性损害,有效保护神经组织,中西医协同治疗更快速有效恢复脊髓功能。 |
| 英文摘要: |
| Objective: To explore the clilical efficacy of low-dose methylprednisolone combined with Buyanghuanwu decoction in the treatment of cervical spinal cord injury without fracture or dislocation. Methods:From January 2018 to January 2020,93 patients with cervical spinal cord injury without fracture or dislocation were treated,including 57 males and 36 females,aged from 29 to 82 years old with a mean of(53. 7±11.9)years.The patients were divided into the low-dose methylprednisolone combined with Buyanghuanwu decoction group (47 cases)and the simple low-dose methylprednisolone group (46 cases) according to the random table method.The Japanese orthopedic association (JOA) score of spinal cord function,the improvement rate of neural function and the neck dysfunction index (NDI) score were compared between two groups pre-treatment and post-treatment 1 month,3month and the final follow-up respectively. Results: All the patients were followed up from 12 to 24 months, with an average of 15.9 months.The scores of JOA and NDI in the low-dose methylprednisolone combined with Buyanghuanwu decoction group were 10.25±3.43、28.13±4.52 before treatment,and 13.08±2.52、17.67±4.15 one month after treatment,and 14.38±3.36、12.53±3.59 three months after treatment,and 15.01±2.58、9.87±2.76 at final follow-up,respectively;and in the simple low-dose methylprednisolone group were 10.29±3.12、27.81±5.78 before treatment,and 12.11±2.35、19.39±3.83 one month after treatment,and 13.05±3.07、15.91±4.75 three months after treatment,and 14.86±2.27、10.36±3.07 at final follow-up,respectively.Post-treatment JOA and NDI of two groups were significantly higher than Pre-treatment(P＜0.05).There was no significant difference in JOA and NDI between two groups at the final follow-up(P＞0.05).The above items in low-dose methylprednisolone combined with Buyanghuanwu decoction group was better than that of simple low-dose methylprednisolone group one month and three months after treatment(P＜0.05).The improvement rate of neural function in simple low-dose methylprednisolone group was （68.29±10.15）% and in low-dose methylprednisolone combined with Buyanghuanwu decoction group was（69.11±11.73）%,there was no significant difference between two groups(P＞0.05). Conclusion: Low-dose methylprednisolone combined with Buyanghuanwu decoction in the treatment of cervical spinal cord injury without fracture or dislocation,combined with the advantages of traditional Chinese medicine,can reduce secondary damage, protect nerve tissue, and recover spinal cord function more quickly and effectively. |
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