CAJ | 학술논문

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.
목적 탐토서신경생장인자(mNGF)연합갑고알재대미행격소충격치료적급성흉요추골절합병불완전성척수손상(ISCI)환자중적응용개치.방법 대2007년10월지2010년9월상후8h미진행격소충격치료적급성흉요추골절합병ISCI적56례환자자료진행회고성분석,안조술후처리방법불동분위2조:mNGF연합갑찬알조(연합조,28례)화단순사용갑고알조(단순조,28례).비교술후회복정황,비교량조환자치료전、치료후1주、8주급12개월미국척수손상협회(ASIA)표준적신경공능평분、일상생활활동(ADL)평분급신경공능개선솔. 결과 소유환자획12 ～48개월(평균20개월)수방,무환자사망,무창구감염；술후평균10개월식골획융합.치료후1주、8주급12개월량조신경공능평분급ADL평분균명현고우치료전,제단순조재1주시신경공능평분차이무통계학의의(P＞0.05),여차이균유통계학의의(P＜0.05),차치료후연합조각시간점평분균우우단순조,차이유통계학의의(P＜0.05).술후1주、8주급12개월연합조적신경공능개선솔분별위32.1％ (9/28)、82.1％ (23/28)화92.9％ (26/28),균우우단순조적25.0％ (7/28)、50.0％ (14/28)화71.4％ (20/28),기중8주화12개월차이유통계학의의(P＜0.05). 결론 여단순응용갑찬알비교,mNGF여갑고알연합치료ISCI가촉진척수손상적회복,개선신경공능.
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.