甲基强的松龙在脊柱非创伤性疾病治疗中的应用PPT演示课件.ppt
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1、甲基强的松龙在脊柱非创伤 性疾病治疗中的应用 Methylprednisolone Use in Orthopedic Conditions (Non-traumatic Spinal Diseases),MP的药理作用 Pharmacologic Effect of MP in SCI (Hall 1981-85),抑制SCI后脂质过氧化的程度 减轻SCI后损伤部位脊髓血流量下降的程度 提高SCI后Na+-K+ATP酶的活性 支持SCI后的能量代谢 1. Inhibits lipid peroxidation 2. Increases blood flow to site of injury
2、 3. Stimulates Na+-K+ATPase activity 4. Promotes energy metabolism,MP的药理作用 Pharmacologic Effect of MP in SCI (Hall 1981-85),5.减少局部乳酸含量,提高丙酮酸含量 6.抑制Ca+ +内流,减轻纤维蛋白的降解 7.抑制中性粒细胞和巨噬细胞向损伤部位的浸润 8.抑制损伤后炎症介质及炎症性细胞因子的产生 5. Reduces local lactic acid content, increasing pyruvic acid content 6. Suppresses Ca+ +
3、 influx, reducing fibrin degradation 7. Inhibits neutrophil and macrophage infiltration into the injured site 8. Depresses the production of inflammatory mediators and cytokines after injury,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 Relieving edema of cell membranes of spinal cord and n
4、erve roots Inhibiting lipid peroxidation of nerve cell membrane, axons and dendrites Suppressing general inflammatory reaction,MP在脊柱非创伤性疾患中应用的理论依据 Theoretical Support for MP in Treating Non-traumatic Spinal Diseases,4、间接改善局部血液循环 5、抑制细胞的凋亡 6、减轻再灌注损伤 4. Indirectly improving local blood circulation 5.
5、Inhibiting apoptosis 6. Relieving reperfusion injury,MP在脊柱非创伤性疾患中应用的理论依据 Theoretical Support for MP in Treating Non-traumatic Spinal Diseases,常见的脊柱非创伤性疾患 Common Non-traumatic Spinal Diseases,1、慢性压迫性颈脊髓病 2、胸椎管狭窄症 3、腰椎间盘突出症及腰椎管狭窄症 4、脊柱肿瘤 5、脊柱结核 Chronic compressive cervical myelopathy Stenosis of thora
6、cic spinal canal Lumbar disc protrusion and stenosis of lumbar spinal canal Spinal tumors Tuberculosis of spine,MP应用现状及方法 Current Use of MP,指征: 1.脊髓或神经严重受压者 2.术中或术后可疑有神经系统损伤 Indication 1. Severe compression of spinal cord or nerves 2. Suspected nerve injury during or after the operation,MP应用现状及方法 Cu
7、rrent Use of MP,方法: 1. 术中或术后可疑有神经系统损伤时, 按照NASCIS II方案应用MP冲击疗法。 2. 其他情况时,应用剂量无统一认识。 Methods 1. MP therapy as per NASCIS II proposal can be applied in cases of suspected nerve injury during or after the operation 2. No consensus on the dosage in other situations,脊柱外科疾病(颈椎) Surgical Treatment of Spine
8、Diseases (cervical spine),临床常见疾病及治疗方法 1.颈椎骨折脱位切开复位内固定 2.颈椎病前路、后路减压、固定、融合 3.颈椎肿瘤切除 Common diseases and treatments 1. Open reduction and internal fixation of fracture-dislocation of cervical spine 2. Anterior or posterior decompression , fixation and fusion for cervical spondylosis 3. Resection of cer
9、vical spinal tumors,脊柱外科疾病(颈椎) Diseases of Spine Surgery (cervical spine),车祸伤 左侧C6神经根损伤 Car crash injury Neurologically deficit of C6 nerve root on left side,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 scre
10、w fixation,前路椎间盘切除、植骨、内固定 Anterior ACDF and 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,脊柱外科疾病(颈椎) Diseases of Spine Surgery (cervical spine),脊柱外科疾病(颈椎) Diseases of Spine Surgery (cervical spine),后路C3-7椎管成形术+前路C4-5椎间盘
11、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,脊柱外科疾病(颈椎) Diseases of Spine Surgery (cervical spine),脊柱外科疾病(颈椎) Surgical Treatment of Spine Diseases (cervical spine),4. 颈椎后纵韧带骨化、黄韧带骨化减压手术 5. 颈椎畸形的矫正 6
12、. 颈椎结核病灶清除术 4. Decompression of ossification of posterior longitudinal ligament and ligamenta flava of cervical spine 5. Correction of cervical spine malformation/deformity 6. Focus clearance of tuberculosis of cervical spine,颈椎后纵韧带骨化,脊髓严重受压,单开门术后 Ossification of posterior longitudinal ligament of c
13、ervical spine, severely compressed spinal cord,post-open door laminoplasty,脊柱外科疾病(颈椎) Diseases of Spine Surgery (cervical spine),颈椎结核,椎管内脓肿 Tuberculosis of cervical spine, intraspinal abscess,脊柱外科疾病(颈椎) Diseases of Spine Surgery (cervical spine),颈椎椎板切除术后后凸畸形 Post-laminectomy cervical Kyphosis,脊柱外科疾病
14、(颈椎) Diseases of Spine Surgery (cervical spine),颈椎前路松解+后路松解+前后路固定、矫正、融合 Combined anterior and posterior release, fixation, correction and fusion,脊柱外科疾病(颈椎) Diseases of Spine Surgery (cervical spine),手术常见并发症 * 喉上神经、喉返神经水肿 * 神经根牵拉损伤 * 反应性脊髓水肿 * 脊髓损伤 Common complications Edema of superior laryngeal ner
15、ve and recurrent laryngeal nerve Stretch injury of nerve roots Responsive edema of spinal cord Spinal cord injury,脊柱外科疾病(颈椎) Surgical Treatment of Spine Diseases (cervical spine),甲强龙对颈前路术后耳鼻喉并发症的影响 Effects of MP on ENT Complications After Anterior Cervical Decompression,给药方法 分别于术后即刻,术后12小时,24小时按1mg/
16、kg的剂量静脉注射MP Medication: 1mg/kg MP is administered intravenously at the end of operation, 12hr, and 24hr after operation separately,Eur-Spine-J 2003 12(1) 84-90,甲强龙对颈前路术后耳鼻喉并发症的影响 Effects of MP on ENT Complications After Anterior Cervical Decompression,评价指标: -客观指标: 根据内窥镜评价咽、喉黏膜 受损的范围 -主观指标: 患者自觉手术对吞咽
17、的影响 Evaluation indicators: Objective indicators: Accessing the range of throat mucous membrane lesion according to endoscope Subjective indicators: Patients perceptions about the influence of operation on swallowing,Eur-Spine-J 2003 12(1) 84-90,甲强龙对颈前路术后耳鼻喉并发症的影响 Effects of MP on ENT Complications A
18、fter Anterior Cervical Decompression,结论: 甲强龙可减轻颈前路术后咽、喉黏膜受损的程度、减少呼吸系统并发症的发生。 Conclusions: MP can relieve the damage of throat mucous membrane after anterior cervical decompression and reduce the complications of respiratory system,Eur-Spine-J 2003 12(1) 84-90,北医三院的治疗方案 Regimens in Peking University
19、Third Hospital,甲强龙用法: (1)未发生急性脊髓损伤 120mg, 静脉输入,小壶给药 持续3-5天 不需要逐渐减量 Treatment with MP (1)No acute spinal cord injury 120mg, intravenous injection, administered via Act-o-Vial Once per day for 3 to 5 days Need not gradually decrease the dosage,北医三院的治疗方案 Regimens in Peking University Third Hospital,甲强龙
20、用法: (2)术中发生急性脊髓损伤 按照急性脊髓损伤治疗方案 30mg/kg(冲击量),静注,持续20分钟 5.4mg/kg/小时(持续量),静注,持续23小时 Treatment with MP (2) In case of acute spinal cord injury occurred during OP According to the regimens of MP for ASCI 30mg/kg(bolus), iv, for 20min. 5.4mg/kg/hr (infusion), iv, for 23hr.,解放军总医院骨科应用MP于颈椎病的外科治疗 Use of MP
21、in the Surgical Treatment of Cervical Spondylosis in Department of Orthopaedics, General Hospital of PLA*,入选标准: 年龄60岁 确诊为脊髓型颈椎病 手术方式为颈前路减压固定 Inclusion Criteria: Age 60 years old Final diagnosis is cervical spondylotic myelopathy Treatment: anterior cervical decompression and fixation,* Peoples Liber
22、ation Army,排除标准: 有脑部疾患者 有胸、腰段脊髓或神经根病变 合并神经根型颈椎病或OPLL 先天性颈椎管狭窄 MRI T2加权像有高信号 Exclusion Criteria: Those who have Brain disease Thoracic and lumbar myelopathy or radiculopathy Cervicalspondylotic radiculopathy or OPLL Simultaneous congenital cervical spinal stenosis High signal intensity at MRI T2WI,解放
23、军总医院骨科应用MP于颈椎病的外科治疗 Use of MP in the Surgical Treatment of Cervical Spondylosis in Department of Orthopaedics, General Hospital of PLA*,病例资料: A组(N=22) 小剂量。MP80-240mg/次,每天2次,术后应用持续5-7天。 Data of the cases: Group A (N=22) Low dose, MP 80-240mg, b.i.d, 5-7days after operation,解放军总医院骨科应用MP于颈椎病的外科治疗 Use o
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