胸腰椎过伸骨折合并弥漫性特发性骨肥厚症的临床研究

目的分析合并弥漫性特发性骨肥厚症(DISH)胸腰椎过伸骨折的损伤机制、损伤特点,以指导治疗方案的选择。方法回顾性分析自2007-01—2015-12诊治的95例合并DISH胸腰椎过伸骨折,根据X线片、CT及MRI评估脊柱损伤类型:前柱经椎间盘损伤44例(46.3%),经骨损伤41例(43.2%),混合型损伤10例(10.5%)。所有患者均行脊柱后路切开复位椎弓根钉内固定手术治疗。结果术后3例出现切口愈合不良,给予换药、抗生素治疗后痊愈。术后X线片显示8枚椎弓根钉位置不佳。在治疗期间,4例出现贫血,5例出现全身炎症性反应综合征(SIRS),4例抗甲氧西林金黄色葡萄球菌感染(MRSA),5例肺或肾脏衰竭,2例肺部感染,1例泌尿系感染,1例出现褥疮。4例在创伤后3个月内死亡,死亡患者年龄75~88(81.7±4.1)岁。结论随着高龄人口及脊柱代谢疾病的增多,DISH患者中出现的胸腰椎过伸损伤也会随之增加。临床骨科医师要充分认识合并DISH胸腰椎过伸骨折的特点,以便制定较为合理的治疗方案。

Clinical study of thoracolumbar spine hyperextension fractures combined with diffuse idiopathic skeletal hyperostosis

Objective To analyze epidemiological data,trauma mechanism,injury characteristics in diffuse idiopathic skeletal hyperostotic (DISH) spines for guidance of the choice of treatment options.Methods Ninety-five patients with thoracolumbar hyperextension fracture combined with DISH between January 2007 and December 2015 were reviewed retrospectively.According to X-ray,CT and MRI assessment of spinal injury pattern,transdiscal injury in the anterior column occurred in 44 cases(46.3％),and transosseous injury in 41 cases(43.2％),10 injuries(10.5％) showed mixed types with vertebral and discal affection.All patients underwent posterior reduction and pedicle screw fixation surgery.Results Three patients had wound healing disorder.There were 8 pedicle screw misplacements.In the course of treatment,4 cases of anemia,5 cases of systemic inflammatory response syndrome,4 cases of methicillin-resistant staphylococcus aureus colonizations,5 cases of pulmonary or renal organ failure,2 cases of pneumonia,a urinary tract infection,and a decubitus were recorded.Four patients died within 3 months after trauma.The average age of the deceased patients was 75-88(81.7±4.1)years.Conclusion Because of the "aging population" and implications of metabolic diseases on an "aging spine",the incidence of fractures in DISH will probably rise.Surgeons should be aware of preexisting alterations in traumatized spines and the impact on therapeutic decisions.