强直性脊柱炎胸腰椎骨折的损伤特点和治疗

Injury characteristics and treatment of thoracolumbar fractures in ankylosing spondylitis

目的分析强直性脊柱炎胸腰椎骨折的损伤特点,探讨治疗方法。方法强直性脊柱炎胸腰椎骨折11例,保守治疗1例(L1压缩性骨折者);手术治疗10例,其中前路手术减压内固定3例,后路椎弓根螺钉系统复位内固定、植骨7例。结果切口无感染,无脑脊液漏。1例T12L1骨折行后路椎弓根螺钉系统复位内固定并植骨术(未行椎管探查或减压),麻醉苏醒后发现脊髓神经症状由术前的C级加重为B级;1例L3～5骨折伴马尾神经损伤行前路手术后第2天出现内固定松动、骨折椎再次移位,脊髓神经症状加重,再次行前路内固定取出和后路长节段椎弓根螺钉系统固定植骨术。患者均获得随访,时间10个月～5年,平均(32±4.8)个月,手术患者中8例植骨于6个月获得融合,2例不能明确是否融合。后期未出现内固定松动或断裂现象。脊髓神经损伤者除1例A级无改变、1例C级加重为B级(末次随访时为C级)、1例D级加重为A级外,其余3例有Ⅰ～Ⅱ级的恢复。9例无腰背痛,2例遗留轻度腰背部酸痛。结论强直性脊柱炎胸腰椎骨折患者宜行后路椎弓根螺钉固定、植骨治疗。

Objective To explore the injury characteristics and treatment of thoracolumbar fractures in ankylosing spondylitis（AS）.Methods 11 cases with thoracolumbar fractures in AS were undergone surgical treatment in 10 cases（anterior decompression and fixation in 3 cases,posterior reduction,fixation with pedicle screws and bone graft in 7）and conservative treatment in 1.Results There were no infection and leakage of cerebrospinal fluid.1 case with T12 and L1 fractures got neural function from C to B after operation of posterior fixation without decompression.1 with L3～5 fractures got implant loosening and neural deterioration after anterior fixation and were relieved after posterior revision.All cases were followed-up for 10 months to 5 years（average 32 months）,bone fusion was achieved in 6 months in 8 cases.There was no loosening and breakage of internal fixation in the later followed up.1 case of A got no improvement.1 C aggravated to B was found to restore to B.1 D aggravated to A.The other 3 cases got 1~2 grade recovery.9 got no backache.2 got mild backache.Conclusions Fixation with pedicle screws system plus bone graft fusion is effective treatment for thoracolumbar vertebra fractures in AS.