Molloy S, Price M, Casey A T
Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom.
Spine (Phila Pa 1976). 2001 Dec 15;26(24):E562-4. doi: 10.1097/00007632-200112150-00017.
A questionnaire survey.
To collate and analyze the views of the delegates who attended the European Cervical Spine Research Society (CSRS) meeting on the use of methylprednisolone for acute traumatic spinal cord injury.
The NASCIS II and III studies reported improved neurologic recovery in patients who were treated with methylprednisolone within 8 hours of their acute traumatic spinal cord injury. A number of reported commentaries have criticized these trials. A recent audit in the authors' regional spinal injuries unit in the United Kingdom found that a large percentage of patients were not receiving methylprednisolone. The authors decided to collate the views of the delegates at the CSRS regarding the use of steroids for acute traumatic spinal cord injury.
A questionnaire was created that took into account the positive reported findings as well as the criticisms of the NASCIS studies. Delegates who attended the European CSRS meeting completed this questionnaire.
Seventy-five percent of the delegates answered that they used or recommended methylprednisolone in the treatment of acute traumatic spinal cord injury. Nevertheless, the delegates had an average of 1.5 reservations about administering methylprednisolone. The most common reservation was that they did not think the improvement conferred to the patients by administering methylprednisolone had been clinically or functionally proven. There were reservations about the validity of the statistical analysis used in the NASCIS studies and by the omission of a placebo group in NASCIS III. The majority of the delegates thought it was not medicolegally negligent to withhold the administration of methylprednisolone in the treatment of acute traumatic spinal cord injury.
The use of methylprednisolone in the treatment of acute traumatic spinal cord injury is still controversial. It would appear from a recent prospective audit at the authors' spinal injuries unit that a large percentage of patients in the United Kingdom are not receiving methylprednisolone. Because so much doubt exists, the NASCIS studies should be repeated.
问卷调查。
整理并分析出席欧洲颈椎研究学会（CSRS）会议的代表们对于使用甲泼尼龙治疗急性创伤性脊髓损伤的看法。
美国国立急性脊髓损伤研究（NASCIS）II和III的研究报告称，急性创伤性脊髓损伤患者在损伤8小时内接受甲泼尼龙治疗后神经功能恢复有所改善。一些已发表的评论批评了这些试验。作者所在英国地区脊髓损伤科室最近的一项审计发现，很大比例的患者未接受甲泼尼龙治疗。作者决定整理CSRS代表们对于使用类固醇治疗急性创伤性脊髓损伤的看法。
设计了一份问卷，该问卷考虑了已报告的积极研究结果以及对NASCIS研究的批评意见。出席欧洲CSRS会议的代表们填写了这份问卷。
75%的代表回答他们在治疗急性创伤性脊髓损伤时使用或推荐使用甲泼尼龙。然而，代表们对使用甲泼尼龙平均有1.5项保留意见。最常见的保留意见是他们认为给予患者甲泼尼龙所带来的改善在临床或功能上尚未得到证实。对NASCIS研究中使用的统计分析的有效性以及NASCIS III中未设安慰剂组存在保留意见。大多数代表认为在急性创伤性脊髓损伤治疗中不给予甲泼尼龙在医学法律上不算疏忽。
甲泼尼龙在治疗急性创伤性脊髓损伤中的应用仍存在争议。从作者所在脊髓损伤科室最近的一项前瞻性审计来看，英国很大比例的患者未接受甲泼尼龙治疗。由于存在诸多疑问，NASCIS研究应该重复进行。
