强直性脊柱炎合并胸腰椎骨折的临床分析

Analysis of the thoracolumbar fracture with ankylosing spondylitis

目的:总结强直性脊柱炎合并胸腰椎骨折的临床特点,避免诊断延误。方法:回顾性分析自2005年4月至2007年6月收治的5例强直性脊柱炎合并胸腰椎骨折病例,男4例,女1例;年龄26～72岁,平均44.8岁。分析内容包括:病史、骨性融合椎体数、骨折特点、风湿活动状态等。结果:强直性脊柱炎患病史平均22.6年。骨性融合椎体数平均18.2节。1例为自驾车交通事故,1例有扭伤史,3例无外伤史为应力骨折。2例合并椎体骨折:骨折线分别经T6、T7或L1椎体;3例合并椎间隙骨折:2例骨折线经L1,2椎间隙,1例骨折线经L2,3椎间隙。未见压缩骨折及脊髓或马尾神经损伤。4例血沉及C反应蛋白等急性炎症指标与疼痛程度不相称。非甾体抗炎药均无明显止痛效果。在外院均误诊为强直性脊柱炎"复发",平均延误1.51个月。结论:①骨折好发于强直性脊柱炎中晚期胸腰椎广泛骨性融合者;②好发于下部胸椎和上部腰椎,且多为应力骨折;③可以为合并椎体骨折或椎间隙骨折;④易误认为强直性脊柱炎"复发"而发生误诊、漏诊;⑤中晚期强直性脊柱炎患者腰背痛突然加剧,疼痛程度与急性炎症指标不相称,非甾体抗炎药甚至皮质类固醇疗效欠佳,应考虑到胸腰椎骨折可能。

Objective：To review the clinical features of the thoracolumbar fracture with ankylosing spondylitis （AS） in order to avoid delayed or missed diagnosis. Methods： Five patients of thoracolumbar fracture with AS treated from April 2005 to June 2007 in our department were studied retrospectively ,male 4 cases ,female 1 case ,the age from 26 to 72 years old with an average of 44.8 years. Analysis including ： case history, number of the ankylosed vertebras, characteristic of fracture, active state rheumatism. Results：The patients had the history of AS for average 22.6 years. The mean number of the ankylosed vertebras was 18.2. Of the 5 cases, 1 case encountered traffic accident, 1 case was sprained, and 3 cases without trauma were diagnosed as stress fracture. Two cases were trans-vertebra fracture：the fracture line was through T6, T7, or L1 vertebral body respectively; 3 cases were through the disc space：2 cases were through L1,2 disc space, 1 case was through L2,3. No compression fracture and neurological injury were found. The acute inflammatory index such as ESR and CRP in 4 cases didn＇t correlate with the degree of pain. The non-steroidal anti-inflammatory drugs （NSAIDs） hadn＇t significant effectiveness in relieving pain. The patients were diagnosed as＇ relapse＇ of AS in other hospital, and had been misdiagnosed for average 1.51 months. Conclusion： （1）the fracture is prevalent at the middle or late period of AS when extensive ankylosis has been existed at the thoracolumbar region;（2） the fracture is common at the lower thoracal spine and the upper lumbar spine, and the majority is the stress fracture ; （3） the fracture line may be through the vertebral body, but more often through the disc space ;（4） it is like an exacerbation of AS and therefore to be missed diagnosis ; （5） when the back pain exacerbated suddenly in the middle or late period of AS, the degree of pain not correlating with acute inflammatory index, and the NSAIDs ineffective, the thoracolumbar fracture should be considered.