单纯后方入路治疗合并强直性脊柱炎颈椎骨折

A single posterior surgical procedure for cervical spinal fracture combined with ankylosing spondylitis

目的 总结采取单纯后方入路治疗合并强直性脊柱炎下颈椎骨折的特点及治疗效果.方法 分析2003年6月-2008年6月住院治疗的合并强直性脊柱炎颈椎骨折患者26例,分析受伤机制、损伤严蕈程度、救治过程、手术记录、术后随访记录和康复过程,评价术后神经功能恢复程度及骨折愈合情况.结果 有6例患者采取单纯后方人路手术治疗,脊髓损伤按美国脊髓损伤学会（ASIA）分级：A级2例,B级1例,C级2例,D级1例.所有患者均采取后路复位侧块固定融合手术,2例A级患者分别于术后2,3个月因呼吸功能衰竭死亡.其余4例随访37个月（12～54个月）,骨折均愈合,愈合时间平均3.8个月（3～5个月）,神经功能显著改善.1例患者因发生硬脊膜外血肿症状加重至B级,术后达到D级,C级及D级患者均恢复到损伤前水平,2例A级损伤患者发生低钠血症.本组患者均未发生内固定相关并发症.结论 合并强直性脊柱炎颈椎骨折在骨折端无骨缺损时,复位后对位对线良好者可通过单纯后方入路完成固定融合手术,并可实现骨折稳定愈合.

Objective To summarize the clinical outcome of single posterior fixation and fusion in treatment of cervical spinal fracture combined with ankylosing spondylitis.Methods A total of 26 patients with cervical spinal fracture combined with ankylosing spondylitis admitted for surgical treatment from June 2003 to June 2008 were reviewed to analyze parameters including injury mechanism,injury severity,treatment course,operation records,postoperative follow-up and rehabilitation and evaluate neurologic recovery and fracture healing by using American Spinal Injury Association（ASIA）classification.Results A single posterior surgical procedure was performed in six patients,of whom the spinal cord function were rated at grade A in two patients,at grade B in one,at grade C in two and at grade D in one according to ASIA classification criteria.All patients were treated with posterior reduction and lateral mass fixation plus fusion.Two patients at grade ASIA A died of respiratory failure at 2 and 3 months respectively after operation.The other four patients were followed up for 12-54 months（mean 37 months）,which showed solid fusion at average 3.8 months after operation and significant improvement of neural function.One patient with aggravated symptoms of spinal epidural hematoma at grade ASIA B was improved to grade D postoperatively.The patients at grades C and D recovered to normal.Hyponatremia occurred in two patients at grade ASIA A.There was no instrumentation related complications in all patients.Conclusions For cervical spinal fractures combined with ankylosing spondylitis without bone defect at fracture end,lateral mass fixation and autologous bone graft through a single posterior approach can attain stable fracture healing after sound reduction.