强直性脊柱炎合并颈胸段脊柱骨折脱位的诊治

Diagnosis and treatment of cervicothoracic spinal fractures and dislocations in patients with ankylosing spondylitis

目的:探讨强直性脊柱炎(AS)合并颈胸段脊柱骨折脱位的病理临床特点、治疗方法及围手术期注意事项。方法:回顾分析2001年1月至2009年3月收治手术的13例AS合并颈胸段脊柱骨折脱位病例,男11例,年龄33～60岁,平均46岁;女2例,年龄36～59岁,平均47.5岁。AS病程12～27年,平均14.5年。主要临床表现为颈肩部疼痛,可伴有四肢肌力减弱、上肢感觉麻木等,X线片示颈胸段脊柱连续性中断,HLA-B27阳性。观察术后骨折愈合及脊髓神经功能改善情况(ASIA评分)。结果:13例中,6例行颈前路单间隙减压内固定术,4例行颈前路椎体次全切减压内固定术,1例行颈后路全椎板减压侧块螺钉内固定术,2例行前后联合入路复位减压内固定术。术后随访12～43个月,平均35.6个月,骨折脱位复位良好,均获得骨性融合。术后神经功能除1例A级无明显改善外,其余均有不同程度恢复。围手术期并发症5例。结论:AS合并颈胸段脊柱骨折多为不稳定的三柱骨折,常需手术治疗,术前合理选择手术适应证及术式,可减少并发症,获得较好的神经功能恢复。

Objective：To discuss the pathological and clinical characteristics,methods of therapies and perioperative considerations of cervicothoracic spinal fractures and dislocations in patients with ankylosing spondylitis （AS）. Methods：Thirteen patients with ankylosing spondylitis and cervicothoracic spinal fractures and dislocations were treated from January 2001 to March 2009,including 11 males and 2 females,aged varied from 33 to 60 years （mean 46） in 11 males and from 36 to 59 years （mean 47.5） in 2 females respectively. The symptom duration of AS was from 12 to 27 years （means 14.5 years）. The chief complains were pain around cervical part and shoulder blades, some accompanied with decrease of motor power and sensation in upper or lower limbs. Spine radiographs revealed a displaced fracture of cervicothoracic spine. Laboratory examination presented positive results of HLA-B27 test. Fusion of fracture and ASIA neurological function grade variation were observed. Result： A total of 13 patients, who underwent operation, were followed up for 12 to 43 months （means 35.6 months）. There were 6 patients were treated with anterior cervical discectomy and fusion,4 with anterior cervical corpectomy and fusion, 1 with laminectomy and fusion and 2 with combined anterior and posterior stabilisation. The bone fusion were observed after reduction of fractures and dislocations ultimately. Twelve patients acquired an improved neurological status in different degrees, and only one suffered from persistent neurological impairment loss. The complications occurred in 5 eases during perioperation. Con- clnsion：This study suggests that most cervicothoracic spinal fractures and dislocations in patients with AS are extremely unsta- ble and require operations. If operative method is proper and operative process accurate ,either anterior,posterior or combined approach can achieve good spinal myeloid functional recovery with low rates of operative complications occurrence, under the guidence of imaging manifestation.