Unfallchirurgie

, Volume 21, Issue 1, pp 20–29

Klinische Erfahrungen und Ergebnisse der hochdosierten Methylprednisolontherapie bei Rückenmarkstrauma von 1991 bis 1993

  • C. Gäbler
  • R. Maier
Originalarbeiten

Zusammenfassung

Tierstudien und vor allem auch NASCIS II haben die neuroprotektive Wirkung des Methylprednisolons mit hoher Sicherheit belegt, sie sind jedoch nicht unumstritten. An der Universitätsklinik für Unfallchirurgie, Wien, erhielten vom 13. 4. 1991 bis 30. 11 1993 31 Patienten mit Wirbelsäulentrauma und Querschnittssymptomatik Methylprednisolon in Megadosis mit einem Bolus von 30 mg/kg Körpergewicht, gefolgt von einer Erhaltungsdosis von 5,4 mg/kg KG/h für 23 Studen. Bei 27 dieser Patienten wurde innerhalb von acht Stunden die primäre operative Reposition und Stabilisierung durchgeführt. Der Nachuntersuchungszeitraum lag zwischen ein bis 3,2 Jahren. Es fand sich bei allen Patienten (100%) mit inkompletter Querschnittssymptomatik (n=18) eine deutliche Besserung und immerhin bei drei Patienten (23.1%) mit komplettem Querschnitt (n=13). Im Vergleich dazu überblicken wir 113 Patienten mit kompletter oder inkompletter Querschnittssymptomatik, die in den Jahren 1980 bis 1990 an der ehemaligen I. Universitätsklinik für Unfallchirurgie aufgenommen wurden und nach unseren derzeitigen Kriterien Methylprednisolon hätten erhalten sollen.

Clinical results of high-dose methylprednisolone therapy in spinal-cord injuries from 1991 to 1993

Abstract

Studies in animals and especially the NASCIS II study illustrated the neuroprotective effects of methylprednisolone, but they are disputed. At the University Clinic of Traumatology, Vienna, 31 patients with spinal cord injuries were given methylprednisolone as a bolus of 30 mg/kg body weight followed by a maintenance dose of 5.4 mg/kg body weight/h for another 24 hours. Twenty-seven patients were stabilised within 8 hour, 2 patients were not operated on, because of their low prognosis. Two patients could be treated conservatively, because the spinal fractures were supposed to be stabile. Then follow-up studies of these patients were between 1 and 3,2 years. All patients (100%) with incomplete neurologic deficits (n=18) showed a significant recovery and even 3 patients (23.1%) with primarily a complete tetraplegia (n=13) showed a nearly entire recovery. Compared to these results we look back at 113 patients with complete and incomplete neurologic deficits who were treated at the I. University Clinic of Traumatology, Vienna, and would have got methylprednisolone following our current management procedures.

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Copyright information

© Urban & Vogel 1995

Authors and Affiliations

  • C. Gäbler
    • 1
  • R. Maier
    • 1
  1. 1.Universitätsklinik für UnfallchirurgieWien

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