强直性脊柱炎下颈椎骨折的临床回顾性分析

Retrospective study on the treatment of ankylosing spondylitis with cervical spine fracture:8 cases report

目的:探讨强直性脊柱炎下颈椎骨折的手术方式和疗效。方法:自2003年1月至2011年10月,对采用手术治疗(7例)和保守治疗(1例)的强直性脊柱炎下颈椎骨折患者进行回顾性分析,8例均为男性,年龄27～49岁,平均41岁。所有骨折经CT、MRI证实,其中6例骨折伴脊髓损伤症状。1例采用头颈胸支具保守治疗,其余7例手术治疗,手术方式包括单纯前路(5例)、单纯后路(1例)和联合前后路(1例);术后随访根据CT等影像学检查骨折融合情况,并根据Frankel分级的改变来评估脊髓损伤是否改善。结果:8例患者均获随访,时间4～38个月,平均18个月。7例患者获得骨性融合,无脊髓损伤患者(3例)术后随访仍无脊髓神经损伤,脊髓损伤患者(5例)术后随访各获得不同程度恢复。7例患者Frankel分级平均改善1级,1例患者骨折延迟愈合(随访中)。结论:强直性脊柱炎下颈椎骨折是一种相对特殊性的损伤,容易发生骨折移位损伤颈髓,应尽早采用手术治疗,手术方式则根据具体情况综合选择。

Objective：To discuss surgical procedures and curative effect of ankylosing spondylitis with cervical spine fracture. Methods：From January 2003 to October 2011,8 patients with ankylosing spondylitis with cervical spine fracture were respectively treated by surgical treatment（ 7 cases） and conservative treatment （1 case）,8 cases were male with an average of age 41 years old（ranged,27 to 49）. All patients were confirmed by CT and MRI,and 6 cases combined with spinal cord injury. One case was treated with skull-neck-thorax model,7 cases were treated by surgery. The procedures included anterior approach（5 cases）,posterior approach（1 case）,and combined anteroposterior approach （1 case）. Fracture fusion condition were evaluated according to CT at the final following up,improvement of spinal cord injury were assessed according to Frankel classification. Results：Eight patients were followed up from 4 to 38 months with an average of 34 months. Seven cases obtained bone healing,3 patients without spinal cord injury remained intact after operation,5 patients with spinal cord injury improved at different degree after operation. Frankel classification of 7 patients were improved 1 degree ,and 1 case delayed union for following up. Conclusion：Ankylosing spondylitis with cervical spine fracture is a special kind of trauma ,which have a high rate of neurological deficits. Surgery should be performed as early as possible,and procedures were chosen depending on particular case.