强直性脊柱炎合并脊柱骨折脱位的手术治疗

目的探讨强直性脊柱炎合并脊柱骨折脱位的临床特点及手术治疗效果。方法 2009年10月2010年6月,共收治6例强直性脊柱炎合并脊柱骨折脱位患者,其中男5例,女1例;年龄38～76岁,平均48.6岁。下颈椎骨折脱位3例,2例为颈5-6、1例颈6-7;胸腰段骨折脱位3例,为胸10-11、胸11-12、胸12-腰1各1例。6例患者中除1例术前神经功能为Frankel分级E级,其余5例均有不同程度的神经损伤。6例患者均行手术治疗,下颈椎骨折脱位采用前后联合入路复位及固定,胸腰段骨折脱位采用后路切开复位及椎弓根螺钉固定。术后观察手术节段内固定位置及骨融合情况,评估神经功能恢复情况,记录手术并发症。患者随访10～18个月,平均14.2个月。结果所有患者术后均未出现切口感染;脑脊液漏1例,换药对症处理3周后愈合。1例颈5-6骨折脱位患者行前路手术后第2天出现内固定移位,骨折椎再次脱位立即二次行前后联合入路复位固定术;3例术后神经功能由术前Frankel C级恢复至D级,2例无明显改善（术前均为A级）,1例较术前加重（术前E级,术后为A级,经再次手术减压并康复治疗6个月后恢复至D级）。随访期间均达骨性融合,未出现内固定松动断裂移位现象。结论强直性脊柱炎脊柱骨折好发于下颈椎及胸腰段;对于下颈椎骨折脱位宜行前后联合入路复位固定,而胸腰段骨折宜行后路长节段椎弓根螺钉固定,术中应先充分减压后再精细复位,避免加重神经损伤。

Surgical Management of Spine Fracture and Dislocation in Ankylosing Spondylitis

Objective To explore the clinical characteristics of spinal fracture and dislocation in ankylosing spondylitis（AS） and its surgical treatment effect.Methods From October 2009 to June 2010,six cases with spinal fractures in AS underwent surgical treatment.There were 5 males and 1 female with an average age of 48.6 years（38-76 years old）.The preoperative neural function of one case was grade E according to the Frankel classification and different degrees of neural damage could be found in other 5 cases.Three cases of lower cervical fractures underwent the operation with a combined posterior-anterior approach.Three cases of thoracolumbar fracture underwent the operation with posterior approach（posterior reduction,fixation with pedicle screws and bone graft）.The situation of internal fixation and bone fusion was observed after operation,the neural function had been evaluated and the postoperative complications was recorded.Results All of the six patients were followed up for 10-18 months（mean 14.2 months）.There was no incision infection.One patient with cerebrospinal fluid leakage was cured with conservative treatment for three weeks.One patient with C5-6 fracture and dislocation got anterior implant loosening and fracture-dislocation recurrence in the second day after the operation and underwent a combined posterior-anterior operation immediately.Three cases got remarkable neuronal function improvement after the operation.Two cases were remain primary situation.One case was aggravated from preoperative grade E grade to postoperative grade A and recovered to grade D after recovery treatment for 6 months.Bone fusion was achieved in all cases.There were no loosening and breakage of internal fixation in the later followed up.Conclusions Lower cervical and thoracolumbar spine are the usual locations of fracture in AS.A combined posterior-anterior surgical approach is effective for lower cervical fractures and posterior long-segmental reduction and the fixation is a desired select for thoracolumbar fractures.