强直性脊柱炎脊柱骨折的治疗

目的 了解强且性脊柱炎(AS)脊柱骨折治疗的特点及注意事项。方法对19例AS脊柱骨折病例进行回顾性分析硬随访,19例中颈椎骨折11例,9例发生在C5-7间;胸腰椎骨折8例,7例为应力骨折,均发生存T10-L2间。二柱骨折16例。9例并发脊髓损伤,其中8例为颈椎骨折。所有19例患者均接受了手术治疗。颈椎骨折或脱位采用了4种手术方式,其中9例做了前路间盘切除或椎体次全切除、椎间值骨加钢板内固定术。胸腰椎骨折也做了4种术式,其中5例的术式为后路长节段固定加前、后联合融合,结果术岳18例患者获得了平均46．4个月的随访。并发脊髓损伤的9例患者,术后8例的神经功能有恢复。18例患者的骨折部位均已骨性愈合一术中并发脊髓损伤2例,因脑血管意外死亡1例,并发肺炎2例。结论 AS脊柱骨折好发于下颈椎及胸腰段,大多为三柱骨折,颈椎骨折并发脊髓损伤的发生率较高。胸腰椎多为应力骨折一手术治疗可使大多数患者的骨折愈合良好,神经功能有不同程度的恢复。对颈椎骨折患者,可采用前路椎体问植骨、钢板内固定的术式;而对于胸腰椎骨折,主张后路长节段固定,前、后联合植骨融合,术中及术后均可能出现并发症,应注意预防或避免。

Treatment of spinal fractures complicating ankylosing spondylitis

Objective To study the treatment of spinal fractures in ankylosing spondylitis Methods Nineteen cases of spinal fractures complicating ankylosing spondylitis admitted in our hospital were studied retrospectively Results All of 19 cases were up to the diagnosis standards of ankylosing spondylitis Eleven patients had cervical fracture and 8 had thoracolumbar fracture Of the patients with cervical fracture,fractures occurred at C 5-7 in 9 patients Of the patients with thoracolumbar injury,stress fractures were seen in 7 patients and all of seven fractures occurred at T 10 L 2 Sixteen of the 19 patients sustained fractures through three columns of the spine Nine patients had spinal cord injures; eight of the 9 cases had cervical fracture All of the 19 patients were treated operatively Four different surgical procedures were used in patients with cervical fracture; decompression,fusion and stabilization with instrumentation by anterior approach were performed in 9 patients Of the patients with thoracolumbar fractures,four different operations were performed; fusion by both anterior and posterior approach plus a long posterior instrument were used in 5 cases Eighteen patients had an average follow up period of 46 6 months Nine patients with preoperative neurological deficits improved in 8 and was stabilized in 1 Radiographic evidence of fusion was observed in all of the 18 patients Two patients suffered neurological deterioration during surgery One patient died from cerebrovascular infarction Two patients had pneumonia after the operative procedure Conclusions Spinal fractures in ankylosing spondylitis are associated with a high rate of neurological injury Shearing fracture usually occurs at the lower cervical spine (C 5-7 ) and stress fracture at thoracolumbar spine Most of the fractures involve three columns of spine Surgical intervention may be indicated in this injury Fracture union and neurological improvement can be achieved in most patients treated by operation We suggest that,fusion and stabilization with instrumentation by anterior approach is indicated in most cervical shearing fracture,and a combined fusion by both sides plus a long posterior instrument is probably beneficial in patients with thoracolumbar stress fracture Complications is not rare after surgery and appropriate preventive measures are necessary for these patients