ﺑﺮرﺳﯽ ﺗﺄﺛﯿﺮ ﺗﺠﻮﯾﺰ ﭘﯿﺸﮕﯿﺮاﻧﻪ و در ﺣﯿﻦ ﻋﻤﻞ ﺟﺮاﺣﯽ ﻣﺘﯿﻞ ﭘﺮدﻧﯿﺰوﻟﻮن ﺑﺎ دوز ﺑﺎﻻ، ﺑﺮ ﭘﯿﺶ آﮔﻬﯽ ﻣﺪاﺧﻠﻪ ﺟﺮاﺣﯽ در ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﻣﯿﻠﻮﭘﺎﺗﯽ ﺳﺮوﯾﮑﺎل

The Effect of High dose Methylprednisolone Administration on Clinical Outcome and Complication of Surgical Treatment of Cervical Spondylotic Myelopathy

زﻣﯿﻨﻪ و ﻫﺪف: ﻧﺘﺎﯾﺞ ﺑﺮﺧﯽ ﻣﻄﺎﻟﻌﺎت اﺳﺘﻔﺎده از ﻣﺘﯿﻞ ﭘﺮدﻧﯿﺰوﻟﻮن را ﺟﻬﺖ ﮐﺎﻫﺶ ﻋﻮارض ﺟﺮاﺣﯽﻫﺎي ﺳﺘﻮن ﻣﻬﺮهاي و ﻧﺨﺎع و ﻧﯿﺰ ﺗﺴﺮﯾﻊ روﻧﺪ ﺑﻬﺒﻮدي ﺑﯿﻤﺎران، ﻣﻔﯿﺪ ﮔﺰارش ﮐﺮدهاﻧﺪ. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺑﺮرﺳﯽ ﺗﺄﺛﯿﺮ ﺗﺠﻮﯾﺰ ﭘﯿﺸﮕﯿﺮاﻧﻪ و در ﺣﯿﻦ ﻋﻤﻞ ﺟﺮاﺣﯽ ﻣﺘﯿﻞ ﭘﺮدﻧﯿﺰوﻟﻮن ﺑﺎ دوز ﺑﺎﻻ، ﺑﺮ ﭘﯿﺶ آﮔﻬﯽ ﻣﺪاﺧﻠﻪ ﺟﺮاﺣﯽ، در ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﻣﯿﻠﻮﭘﺎﺗﯽ ﺳﺮوﯾﮑﺎل اﻧﺠﺎم ﮔﺮدﯾﺪ. ﻣﻮاد و روش ﻫﺎ: ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺻﻮرت ﮐﺎرآزﻣﺎﯾﯽ ﺑﺎﻟﯿﻨﯽ ﺷﺎﻫﺪدار ﺗﺼﺎدﻓﯽ ﺑﺮ روي 72 ﺑﯿﻤﺎر ﺑﺎ ﻋﻼﺋﻢ ﺳﺮوﯾﮑﺎل ﻣﯿﻠﻮﭘﺎﺗﯽ ﺷﺎﻣﻞ اﺳﭙﻮﻧﺪﯾﻠﻮز، دژﻧﺮاﺳﯿﻮن دﯾﺴﮏﻫﺎي ﮔﺮدن، اﺳﺘﺌﻮﻓﯿﺖﻫﺎ، ﮐﻠﺴﯿﻔﯿﮑﺎﺳﯿﻮن ﻟﯿﮕﺎﻣﺎن ﻃﻮﻟﯽ ﺧﻠﻔﯽ، ﺿﺨﯿﻢ ﺷﺪن ﻟﯿﮕﺎﻣﺎن ﻓﻼووم، ﻫﺎﯾﭙﺮﺗﺮوﻓﯽ اﺳﺘﺌﻮآرﺗﺮوﺗﯿﮏ ﻓﺎﺳﺖﻫﺎ و ﺳﺎﯾﺮ ﭘﺎﺗﻮﻟﻮژيﻫﺎي ﻏﯿﺮ ﺗﺮوﻣﺎﺗﯿﮏ داراي اﻧﺪﯾﮑﺎﺳﯿﻮن ﻋﻤﻞ ﺟﺮاﺣﯽ، اﻧﺠﺎم ﺷﺪ. در ﯾﮏ ﮔﺮوه )34=n( اﺑﺘﺪا ﻣﺘﯿﻞ ﭘﺮدﻧﯿﺰوﻟﻮن ﺑﺎ دوز ﺑﺎﻻ ﺑﻪ ﻣﯿﺰان mg/kg 12/5 ﺑﻪ ﺷﮑﻞ اﻧﻔﻮزﯾﻮن ورﯾﺪي، در ﻣﺪت 30 دﻗﯿﻘﻪ ﻗﺒﻞ از ﻋﻤﻞ ﺟﺮاﺣﯽ و ﺳﭙﺲ ﺑﻪ ﻣﯿﺰان mg/kg/hr 1 ﺑﻪ ﺷﮑﻞ اﻧﻔﻮزﯾﻮن ﻣﺪاوم داﺧﻞ ورﯾﺪي )ﺗﺎ اﻧﺘﻬﺎي ﻋﻤﻞ و ﻗﺒﻞ از اﻧﺘﻘﺎل ﺑﻪ رﯾﮑﺎوري( ﺗﺰرﯾﻖ ﺷﺪ. در ﮔﺮوه ﮐﻨﺘﺮل )38=n( اﯾﻦ ﺗﺰرﯾﻖ اﻧﺠﺎم ﻧﮕﺮدﯾﺪ. ﺑﯿﻤﺎران ﺗﻮﺳﻂ ﺗﯿﻢ ﻣﻌﺎﯾﻨﻪ ﮐﻨﻨﺪه، ﻗﺒﻞ و ﭘﺲ از ﺟﺮاﺣﯽ )در ﭼﻬﺎر ﻧﻮﺑﺖ: 48 ﺳﺎﻋﺖ، دو ﻫﻔﺘﻪ، ﯾﮏ ﻣﺎه و ﺷﺶ ﻣﺎه ﺑﻌﺪ( ﻣﻮرد ﺑﺮرﺳﯽ ﻗﺮار ﮔﺮﻓﺘﻪ و ﺑﺮاﺳﺎس ﻣﻌﯿﺎرﻫﺎيJapanese Orthopedic Association Score (JOA) و Modified Rankin Scale (MRS) ﻧﻤﺮهدﻫﯽ ﺷﺪﻧﺪ. ﻣﯿﺰان ﻣﺆﺛﺮ ﺑﻮدن ﺗﺰرﯾﻖ ﻣﺘﯿﻞ ﭘﺮدﻧﯿﺰوﻟﻮن، ﺑﺎ ﻣﻘﺎﯾﺴﻪ ﺗﻔﺎوت ﻧﻤﺮه ﺑﯿﻤﺎران ﻗﺒﻞ و ﭘﺲ از ﺟﺮاﺣﯽ در دو ﮔﺮوه اﻧﺠﺎم ﺷﺪ. آﻧﺎﻟﯿﺰ دادهﻫﺎ ﺗﻮﺳﻂ ﻧﺮم اﻓﺰار SPSS ﻧﺴﺨﻪ 22 ﺻﻮرت ﮔﺮﻓﺘﻪ و ﺳﻄﺢ ﻣﻌﻨﺎداري ﮐﻤﺘﺮ از 0/05 در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﺑﯿﻤﺎران دو ﮔﺮوه از ﻧﻈﺮ ﻣﺸﺨﺼﺎت ﺑﺎﻟﯿﻨﯽ و ﻣﺘﻐﯿﺮﻫﺎي ﺣﯿﻦ ﺟﺮاﺣﯽ، ﻧﻈﯿﺮ ﺧﻮﻧﺮﯾﺰي و زﻣﺎن ﺟﺮاﺣﯽ و ﻫﻤﭽﻨﯿﻦ ﻋﻮارض ﭘﺲ از ﺟﺮاﺣﯽ ﻣﺎﻧﻨﺪ ﻋﻔﻮﻧﺖ ﻣﺤﻞ ﻋﻤﻞ و ﺗﺮوﻣﺒﻮز ورﯾﺪ ﻋﻤﻘﯽ و ... از ﻧﻈﺮ آﻣﺎري ﺗﻔﺎوت ﻣﻌﻨﺎداري ﻧﺪاﺷﺘﻨﺪ. در ﺳﻨﺠﺶ ﻣﻌﯿﺎر JOA و MRS ﻗﺒﻞ و در زﻣﺎنﻫﺎي ﻣﺨﺘﻠﻒ ﭘﺲ از ﺟﺮاﺣﯽ ﺑﯿﻦ دو ﮔﺮوه، ﺗﻔﺎوت آﻣﺎري ﻣﻌﻨﺎداري ﻣﺸﺎﻫﺪه ﻧﮕﺮدﯾﺪ. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﻧﺘﺎﯾﺞ ﻣﻄﺎﻟﻌﻪ ﺗﻔﺎوت ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪاي در ﺑﻬﺒﻮد ﻋﻤﻠﮑﺮد ﻋﺼﺒﯽ ﮔﺮوه ﺑﯿﻤﺎران ﺑﺎ ﺗﺠﻮﯾﺰ ﻣﺘﯿﻞ ﭘﺮدﻧﯿﺰوﻟﻮن ﻧﺴﺒﺖ ﺑﻪ ﮔﺮوه ﮐﻨﺘﺮل ﻧﺸﺎن ﻧﺪاد و ﻣﻄﺎﻟﻌﺎت ﺑﯿﺸﺘﺮ در اﯾﻦ زﻣﯿﻨﻪ ﺑﺎ ﺣﺠﻢ ﻧﻤﻮﻧﻪ ﺑﺎﻻﺗﺮ ﭘﯿﺸﻨﻬﺎد ﻣﯽﺷﻮد.

Introduction & Objective: One of the proper methods to reduce the complications of spine surgeries and to accelerate the patient's recovery process is to use methylprednisolone before, during or after surgery. The aim of this study was to investigate the effect of prophylactic administration and high dose methylprednisolone on the prognosis of surgical intervention in patients with cervical myelopathy. Materials & Methods: The study was a randomized controlled clinical trial in patients with cervical myelopathy. Patients with myelopathy who had a surgical indication were included in the study due to spondylosis, degeneration of the cervical intervertebral disks, osteophytes, calcification of the posterior longitudinal ligament, thickening of the ligamentum of flavum, hypertrophic osteoarthritis and other non-traumatic pathologies. In one group, methylprednisolone was injected at high dosages of 12.5 mg/kg intravenous infusion within 30 minutes, and then (after half an hour) at a dose of 1 mg/kg/hr in the form of continuous intravenous infusion (to the end of surgery). In the other group, this injection was not performed. Before and after surgery (four times: 48 hours, two weeks, one month and six months later), the patients were examined by the team and scored in terms of Japanese Orthopedic Association Score (JOA) and Modified Rankin Scale (MRS). The efficacy of high doses of methylprednisolone was compared by comparing the patients' score before and after surgery in two groups. Results: 72 patients participated in this study. 34 patients were injected with methylprednisolone and 38 patients remained in the control group. There was no significant difference between JOA and MRS scores before and at different postoperative times between the two groups. Post-surgical complications were not significantly different between the two groups. Conclusions: There was no significant difference between two groups in terms of intraoperative variables such as bleeding and surgical time, as well as post-operative complications such as surgery site infections and deep vein thrombosis. Finally, according to the findings of the study, it can be argued that the administration of methylprednisolone during surgery cannot contribute to the improvement of neurological function.