强直性脊柱炎颈椎骨折影像学特点及手术方式选择

Diagnosis and surgical treatment of ankylosing spondylitis complicating cervical spine fracture

目的探讨强直性脊柱炎(ankylosing spondylitis AS)合并颈椎骨折的影像学特点和手术方式选择;方法对30例强直性脊柱炎颈椎骨折(ankylosing spondylitis cervical spine fracture ASCSF)患者的影像学特点以及前路、后路和前后路联合三种不同手术方式的结果进行分析;结果强直性脊柱炎颈椎骨折多表现为三柱损伤,多合并相对较重的脊髓损伤,影像学特点根据骨折脱位的不同表现不同,骨折多位于椎间隙部位,部分无明显脱位的患者X线和CT检查易漏诊,MRI检查阳性率较高,治疗上首选外科手术稳定融合和脊髓减压,手术方式可根据骨折脱位情况和脊柱强直情况不同选择不同的稳定方式。结论强直性脊柱炎颈椎骨折一种相对严重的损伤,影像学根据损伤不同表现不同,治疗上以手术稳定脊柱和脊髓减压为主,前路、后路和前后路联合稳定脊柱是主要方式。

Objective To study the clinical characteristic,diagnosis and treatment of ankylosing spondylitis complicating cervical spinal fracture （ASCSF）. Methods 30 cases of ankylosing spondylitis complicating cervical spinal fractures were studied retrospectively,it injury biomechanies and types,imageology,treatment and result were studied. Resuls The violence to lead cervical spine fracture in ankylosing spondylitis was small,Spinal fractures in ankylosing spondylitis were associated with a high rate of neurological injury Most of the fractures involved three columns of spine,The position of fracture mostly happened in the place of intervertebral space,Surgical intervention may be indicated in this injury,Fracturc union and neurological improvement could be achieved in most patients treated bv operation. Conclusion Cervical spine fracuture in ankylosing spondylitis is severely trauma,Fusion and stabilizatiou with instrumentation by anterior or posterior approach is indicated in ankylosiug spondylosing cervical spine fracture.