强直性脊柱炎合并颈椎无骨折脱位型脊髓损伤

目的 总结强直性脊柱炎合并颈椎无骨折脱位型脊髓损伤的临床特征、诊断和手术治疗。方法 1986～2004年，笔者手术治疗累及颈椎的强直性脊柱炎合并无骨折脱位型脊髓损伤27例。结果 本组27例中椎管内韧带骨化18例，脊髓损伤的原因依次为韧带骨化所致的椎管狭窄，椎间盘损伤和椎体后骨刺及椎间不稳定。术前均为不完全性损伤，非手术治疗不提高脊髓功能。术后脊髓ASIA分级平均改善1级。后路手术椎板切除率、出血量、手术时间、术后引流量明显高于不合并强直性脊柱炎的患者。前路手术可达到骨性融合。结论 强直性脊柱炎合并颈椎无骨折脱位型脊髓损伤一般为不完全性损伤，损伤的内因依次为椎管内韧带骨化所致的椎管狭窄、椎间盘损伤、椎间骨赘和椎间不稳定。适当的手术可改善脊髓功能。手术难度大，风险高。

Cervical Spinal Cord Injury with Ankylosing Spondylitis but without Fracture and Dislocation of Cervical Spine

Objective To study the clinical characteristics,the diagnosis and the surgery of the cervical spinal cord injury with ankylosing spondylitis but without fracture and dislocation.Methods Twenty-seven patients with cervical spinal cord injury with ankylosing spondylitis but without fracture and dislocation were treated with surgery from 1986 to 2004.Results There were 18 ligmental ossifications in the spinal canal among 27 patients.The traumatic factors were mild or medium.Through analysis of the clinical manifestation and image information the cause of injury could be ascertained as spinal canal stenosis secondary to the ligmental ossification,the protrusion of the intervertebral disc and the instability of the cervical spine.The spinal cord injury was incomplete,and the non-surgical treatment was not effective to improve the ASIA scale.The postoperative average improvement scale was 1 according to ASIA SCI system.The laminectomy rate,the operative bleeding volume,the operation duration and the postoperative drainage volume were more than the patient without ankylosing spondylitis.The anterior fusion was feasible under the rigid internal fixation,the fusion rate was 100%.Conclusion The spinal cord injury with ankylosing spondylitis but without fracture and dislocation is usually incomplete.The internal cause of injury is the ligmental ossification in the spinal canal,the injury of the intervertebral disc,the osteophyte and the segmental instability.The surgery can improve the spinal cord function,but it is more difficult and risky.