强直性脊柱炎合并脊柱骨折的外科治疗策略

目的：探讨清醒麻醉＋平衡体位下手术治疗强直性脊柱炎（ AS ）合并脊柱骨折的疗效。方法回顾性分析自2006年1月～2011年1月，对33例强直性脊柱炎合并胸腰椎骨折患者采用清醒麻醉＋平衡体位下行手术治疗，其中AS合并颈椎损伤14例，合并胸腰椎骨折19例，AS合并颈椎骨折者，入院后即行Halo-vest固定于平衡体位，在Halo-vest保护下行颈椎前路或后路减压融合为手术，AS合并胸腰椎骨折患者维持患者平衡体位，在清醒麻醉下行后路长节段椎弓根螺钉固定融合手术，经过10～43个月（平均24个月）的随访，随访内容包括术后1周，3，6，12个月X线片、CT，局部疼痛缓解情况（VAS评分），植骨融合情况，内固定是否存在松动断裂现象，矫正角度有无丢失以及脊髓神经恢复情况（ Frankel分级）。结果所有患者均得到随访，16例脊髓损伤者，除1例无明显恢复外，神经功能均有恢复，33例患者骨折部位均骨性愈合，术后随访，无内固定松动断裂及矫正角度丢失，2例患者遗留胸背部疼痛（ VAS评分2分），给予消炎镇痛药物治疗后好转。结论清醒麻醉＋平衡体位下行手术治疗是治疗AS合并脊柱骨折的一种有效的方法。

Ankylosing Spondylitis with Spine Fracture of Surgical Treatment of Strategy

Objective To study the surgical treatment of vertebral fractures in ankylosing spondylitis by wa-king-up anaesthetization and balance position .Methods Thirty-three cases of vertebral fractures and ankylosing spondy-litis patients admitted in our hospital were studied retrospectively .There were 14 patients with Cervical vertebral fractures and ankylosing spondylitis and 19 patients with thoracolumbar vertebral fractures and ankylosing spondylitis in total .We operated by waking-up anaesthetization and balance position .Results All patients were followed up for 10 months to 43 months（average of 24 months）.The X-ray,CT,local pain VAS scale,the mean angle of kyphosis correction ,looseness and displacement of screws and rods ,Frankel Grade improving were collected .Conclusion Surgical intervention by wa-king-up anaesthetization and balance position may be a properway to treat vertebral fractures in ankylosing spondylitis .