颈僵硬畸形的强直性脊柱炎患者并颈椎骨折脱位的手术入路选择

目的：探讨颈椎已僵硬畸形的强直性脊柱炎患者合并外伤性颈椎骨折脱位的合理手术入路.方法：回顾分析2000年3月至2004年3月收治的12例颈椎强直性脊柱炎合并外伤性颈椎骨折脱位患者的临床资料.10例合并不完全性瘫痪,1例完全性瘫痪.3例行前路手术未能纠正脱位而行椎体次全切除减压植骨融合钢板内固定;2例先行前路手术,发现无法复位而立即改为后路手术完成复位、固定后再经前路减压、融合;另7例均先经后路完成脱位复位、侧块固定融合,然后再经前路行减压融合.结果：3例仅行前路内固定者于术后第3～7天发现钢板松动移位,行后路翻修术,通过后路完成了复位固定;9例先行后路手术再行前路融合者均顺利完成脱位复位及固定融合.随访3个月～4年,10例不完全性瘫痪患者2例恢复到伤前水平,8例恢复部分功能;1例完全性瘫痪者术后半年无改善,死于并发症.结论：对于颈椎已发生僵硬畸形的强直性脊柱炎患者发生外伤性骨折脱位时应先经后路复位固定融合,然后再一期行前路减压和植骨融合.

Selection of surgical approach for cervical fracture-dislocation in patients with ankylosing spondylitis

Objective:To explore the rational surgical approach for traumatic cervical fracture-dislocation in patients with ankylosing spondylitis(AS).Method:12 AS patients with ankylosed and deformed cervical spine suffered traumatic cervical fracture-dislocation were treated in our hospital from March 2000 to December 2004.The experience and lesson from the 12 patients was summarized.3 patients were operated first with anterior decompression,reduction,internal fixation and fusion,but no reduction was acquired.2 patients were operated first with anterior approach,during operation,it was found the reduction could not be reached,so the posterior surgery was performed to achieve reduction,fusion and internal fixation,followed by anterior decompression and fusion.The other 7 patients were operated with combined posterior-anterior approach reduction and fixation was accomplished without difficulty.Posterior approach followed by anterior surgery was performed in these patients.Result:3 patients only operating anterior fixation were found with internal fixation failure at 3-7 days postoperation.These patients had to be undergone posterior revision operation,and reduction was achieved.The other 9 patients operated with posterior-anterior approach reduction and fixation were accomplished without difficulty.The follow-up lasted 3 months to 4 years,2 patients with incompletely paraplegia recovered to normal level,8 patients with incompletely paraplegia recovered partial function.One patient with complete paraplegia had no evidence of his neurological status improved with half year and died of complication finally.At the final follow-up,no instrument failure and no evidence of displacement were dated.Conclusion:Posterior reduction and fixation followed by anterior decompression and fusion in one stage is the appropriate treatment for traumatic cervical fracture dislocation in patients with ankylosing spondylitis.