Pettersson K, Toolanen G
Department of Orthopaedics, Umeå University, Sweden.
Spine (Phila Pa 1976). 1998 May 1;23(9):984-9. doi: 10.1097/00007632-199805010-00004.
A prospective, randomized, double-blind study comparing high-dose methylprednisolone with placebo.
To evaluate the efficacy of high-dose methylprednisolone when administered within 8 hours after whiplash injury.
Whiplash injury often results in chronic symptoms. The management of whiplash injuries is controversial, and pharmacologic therapy has received little evaluation. In recent reports, dysfunction of the central nervous system has been indicated in several cases. Methylprednisolone administered within 8 hours after the injury to patients with acute spinal cord injury has been demonstrated to improve the outcome. This procedure was also adopted in a randomized study of cases of whiplash injury in car accidents.
Forty patients, 22 men and 18 women with a mean age of 35 years (range, 19-65), were included in the study, 20 in each of two groups. They were treated for whiplash injury, which they had sustained in car accidents. The patients were enrolled if their diagnoses were complete and treatment had begun within 8 hours after injury. Disabling symptoms severe enough to prevent the patient from returning to work, number of sick days before and after injury, and sick-leave profile after injury were used as parameters for the evaluation of the effects of the treatment. Baseline demographic data were controlled for when statistical analysis had been performed.
At the follow-up examination 6 months after initial treatment, there was a significant difference in disabling symptoms between the actively treated patients and the placebo group (P = 0.047), total number of sick days (P = 0.01), and sick-leave profile (P = 0.003).
The results of this study indicate that acute treatment with high-dose methylprednisolone may be beneficial in preventing extensive sick leave after whiplash injury. However, the number of patients studied was small, and therefore further prospective, controlled studies are needed.
一项前瞻性、随机、双盲研究，比较大剂量甲泼尼龙与安慰剂。
评估在挥鞭样损伤后8小时内给予大剂量甲泼尼龙的疗效。
挥鞭样损伤常导致慢性症状。挥鞭样损伤的治疗存在争议，药物治疗很少得到评估。在最近的报告中，几例病例显示中枢神经系统功能障碍。已证明在急性脊髓损伤患者受伤后8小时内给予甲泼尼龙可改善预后。这一方法也被用于一项关于车祸中挥鞭样损伤病例的随机研究。
40例患者纳入研究，其中男性22例，女性18例，平均年龄35岁（范围19 - 65岁），两组各20例。他们因车祸导致的挥鞭样损伤接受治疗。如果诊断明确且在受伤后8小时内开始治疗，则将患者纳入研究。将严重到足以使患者无法重返工作的致残症状、受伤前后的病假天数以及受伤后的病假情况用作评估治疗效果的参数。在进行统计分析时对基线人口统计学数据进行了控制。
在初始治疗6个月后的随访检查中，积极治疗组与安慰剂组在致残症状（P = 0.047）、病假总天数（P = 0.01）和病假情况（P = 0.003）方面存在显著差异。
本研究结果表明，大剂量甲泼尼龙急性治疗可能有助于预防挥鞭样损伤后长期病假。然而，研究的患者数量较少，因此需要进一步进行前瞻性对照研究。
