强直性脊柱炎合并胸腰椎骨折的手术治疗

Surgical treatment of thoracolumbar vertebral fracture patients with ankylosing spondylitis

目的探讨后路胸腰椎椎弓根螺钉内固定术治疗强直性脊柱炎合并胸腰椎骨折的疗效。方法对2008年1月至2012年3月于郑州大学第一附属医院住院治疗的12例强直性脊柱炎合并胸腰椎骨折患者进行研究，其中男11例，女1例，均采用后路减压、椎弓根螺钉内固定融合手术进行治疗。按照脊柱骨折AO分型，其中A型6例，B型2例，C型4例。骨折发生范围在第10胸椎至第2腰椎之间。回顾性分析其临床及随访资料。采用Frankel分级标准判定患者脊髓神经损伤恢复情况。采用视觉模拟评分法（VAS）对患者骨折局部疼痛的缓解情况进行评定。结果12例患者均成功进行手术，术后随访显示所有患者均恢复良好，其中2例c级（Frankel分级）患者恢复至E级，B级1例回复至E级。术后6个月骨折均愈合，随访期间内固定物无松动、断裂现象。结论后路椎弓根钉内固定术是治疗强直性脊柱炎合并胸腰椎骨折的有效方法。

Objective To study the surgical treatment of vertebral fractures in ankylosing spon- dylitis（AS） by the operation of posterior pedicle screw and lumbar fusion. Methods Twelve cases of the thoracolumbar vertebral fracture and ankylosing spondylitis patients in the first affihated hospital of Zhengzhou university were studied retrospectively. There were 11 male and 1 female patients in total. Back decompression was choosed, fused by bone graft and internal fixated by pedicle screws. According to the AO classification of the spinal fractures, there were 6 patients with type A, 2 patients with type B and 4 patients with type C. The location of these fractures were located in Ti0 - L2. Retrospective analy- sis was carried out and the clinical and follow-up data were analyzed. Results All 12 patients surgery were success and recovered well under the X-ray. Symptoms of patient were improved： 2 cases of grade C went back to grade E; 1 case form grade B went to E. There was no loose connection or breakage in the implant. Conclusions The thoracolumbar vertebral fracture patients with ankylosing spondylitis can be treated well by operation of posterior pedicle screw and lumbar fusion.