强直性脊柱炎脊柱骨折的特点及诊断

目的：探讨强直性脊柱炎脊柱骨折的特点，为其临床诊断与治疗提供参考。方法：回顾性分析1994年1月～2001年10月收治的19例强直性脊柱炎脊柱骨折病例。结果：所有19例患者均符合强直性脊柱炎的诊断标准，其中17例骨折前有平均20．6年的强直性脊柱炎病史，另2例方确诊有强直性脊柱炎。19例中15例有外伤史，其中9例为平地跌倒或扭伤，另4例无外伤史。损伤机制：过伸伤7例，垂直挤压伤2例，侧屈损伤l例，屈曲伤1例，4例不详。颈椎骨折11例，9例发生在C5～C7；包括剪力骨折lO例，应力骨折1例。胸腰椎骨折8例，7例为应力骨折，均发生在T10～L2，1例为L3剪力骨折。19例中经椎间隙骨折12例，经椎体骨折7例。三柱骨折16例，骨折伴脱位5例。9例并发脊髓损伤，其中8例为颈椎骨折。外伤至诊断为骨折的间隔时间为10h～7个月，平均29．6d。2例曾被误诊为脊柱结核。结论：导致强直性脊柱炎患者发生脊柱骨折的外力往往较轻。损伤机制多为过伸伤。骨折好发于下颈椎及胸腰段。剪力骨折多发生在颈椎，大多为三柱骨折，容易伴发脱位，脊髓损伤的发生率较高；应力骨折多发生在胸腰段，脊髓损伤不多见。此类骨折多为经椎间隙骨折，易发生诊断延误。

Characteristics and diagnosis of spinal fractures in the patients with ankylosing spondylitis

Objective To study the characteristics of spinal fractures in ankylosing spondylitis(AS) in order to provide data in its diagnosis and treatment. Methods 19 cases of concomitant spinal fractures following AS, admitted in our hospital between January 1994 and October 2001, were studied retrospectively. Examination of AS, including A-P and lateral X-ray films of bilateral sacroiliac joint, HLA-B27, rheumatoid test and ESR were accomplished in all patients. MRI and CT scan were taken in 12 cases. 4 cases of thoracolumbar stress fracture treated surgically were conformed to pathological examination. 2 cases received preoperative puncture biopsy under CT guidance. In the group, there were 18 males and 1 female aging from 31 to 69 years with an average of 52.6 years. Results All of 19 cases were consistent with the diagnostic standards of AS. 17 of the patients prior to spinal fracture had a history of AS with duration of mean 20.6 years ranging from 8 to 37 years. All of 19 patients had round-backed deformity of different extent. Of 19 patients, 15 cases had a traumatic history. Falls while standing and walking were the cause of injury in 9 patients. The mechanism of injury appeared to be hyperextension in 7. 11 patients had the cervical fracture, and 8 had the thoracolumbar fracture. Of the patients with cervical fracture, 10 patients were due to shearing force, 9 of whom were located at C5-C7. In patients with thoracolumbar injury, stress fractures were seen in 7 patients, all of seven fractures occurred at T10-L2. Fracture through ankylosed disc was seen in 12 and vertebral body in 7. 16 of the 19 patients sustained fractures through three columns of the spine. 5 patients were associated with dislocation. 9 patients had spinal cord injury, 8 of whom were cervical fracture. The period from the injury to the diagnosis ranged from 10 hours to 7 months (mean 29.6 days). Conclusion Spinal fractures in AS can result from a mild trauma, and are associated with a high rate of neurological injury. Most frequent mechanism of the injury is hyperextension. Shearing fracture usually occurs at the lower cervical spine and stress fracture at thoracolumbar spine. Most of the fractures involve three columns of spine; and corresponding dislocation is common. The common fracture line is through the disc space. Delay in diagnosis is not rare.