甲基强的松龙在脊柱非创伤性病治疗中的应用.pptVIP

甲基强的松龙在脊柱非创伤性疾病治疗中的应用Methylprednisolone Usein Orthopedic Conditions(Non-traumatic Spinal Diseases) 北京大学第三医院骨科 孙宇 Yu Sun, MD Professor of Orthopaedic Surgery Peking University Third Hospital Beijing, People’s Republic of China 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 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+ + 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 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 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 thoracic 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Current 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 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