强直性脊柱炎颈椎骨折的临床特征分析和诊断

Clinical manifestation and diagnosis of the cervical spine fracture with ankylosing spondylitis

目的探讨强直性脊柱炎颈椎骨折或脱位的临床特征和诊断中应该注意的问题。方法回顾性分析1986年4月-2004年4月手术治疗累及颈椎的强直性脊柱炎合并颈椎骨折或脱位12例，采用美国脊柱损伤学会（ASIA）神经功能障碍评分评价神经功能，总结临床特征和诊断。结果（1）损伤原因及特征：12例骨折中只有1例为严重外力所致；均为单个运动节段的损伤，其中发生在C6-7之间者为50％；累及前中柱的患者中，经过椎间盘的损伤7例，既经过椎间盘又经过椎体的损伤2例，经过椎体的损伤2例。12例患者中，稳定型损伤3例，不稳定型损伤9例。合并脊髓损伤9例，其中不完全性脊髓损伤7例，完全性脊髓损伤2例，均为治疗过程中颈椎固定不可靠所致的继发损伤。（2）正确诊断率：发生在C6-7水平者X线平片的正确诊断率为17％，C5-6水平者50％，以上者100％；CT100％，MRI 92％。仅有1例合并后纵韧带骨化。结论强直性脊柱炎累及颈椎时颈椎发生骨折和脱位的可能性较大，致伤外力较小；如果发生骨与关节的损伤，多数为不稳定型损伤，神经损伤的可能性较大，容易造成继发损伤。骨与关节损伤多数位于C6-7水平，普通X线平片容易漏诊，骨折脱位一旦漏诊，可能由于随之而来的继发性神经损伤使脊髓损伤出现或加重，导致严重后果。

Objective To study the clinical manifestation and the related diagnostic problem of the cervical spine fracture with ankylosing spondylitis. Methods Twelve patients of cervical spine fracture with ankylosing spondylitis were treated surgically from 1986 to 2004. All cases were studied retrospectively, complete clinical data were kept. The neurological function was evaluated by ASIA, the clinical manifestation and diagnosis were summarized. Results The causes and characteristic of injury： one of 12 injuries was caused by severe trauma; all of the eases was mono-segment injury those in 6 eases were happened between C6 and C7, 7 eases were through the intervertebral disc, 2 eases were through the vertebral body and the intervertebral disc, and 2 eases whose injuries were through the vertebral body only. 3 cases were stable injuries, another Nine eases were instable injuries. 9 eases were accompanied by spinal cord injury （SCI）, among them 7 were incomplete and another 2 were complete. The complete injury was secondary to the instability of the injured cervical spine during treatment. The accuracy of the diagnesis of the fracture by plain radiographs was 17% for C6-7, 50% for C5-6 and 100% for levels above. But for all levels by CT scan it was 100% and by MRI 92%. Only One ease was accompanied by OPLL. Conclusion The possibility of the fracture and dislocation of the cervical spine is increased and the force of trauma needed is decreased when the cervical spine is involved in the ankylosing spendylitis, the injuries of the bone and joints are often instable, the accompanied SCI were common and easily worsened by secondary injury. The common level of injury is C6-7 and easily misdiagnosed by plain radiographs. If the fracture and dislocation are misdiagnosed there would be a dangerous deterioration of SCI by the seeondary neural injury.