强直性脊柱炎合并脊柱骨折12例手术治疗体会

Experience in Surgical Treatment of 12 Patients with Ankylosing Spondylitis and Spinal Fracture

目的 探讨强直性脊柱炎（A S ）合并脊柱骨折的治疗方法及临床效果。方法 回顾性分析2010年1月至2012年12月在本院治疗的12例AS合并脊柱骨折患者的临床资料。下颈椎骨折3例全麻下行颈椎前后路联合手术；胸腰段骨折9例行后路切开长节段椎弓根钉棒系统内固定术。结果 入院的12例患者，经手术抢救治疗以后，成功救治11例，1例因抢救无效死亡，死亡率为8．33％。以上11例患者均随访了1．5年，其中1例患者因呼吸衰竭而死亡，1．5年存活率为90．91％。10例患者术后1年X线检查，依据Frankel分级，2例D级患者手术后神经功能基本恢复正常，3例C级患者其中1例基本恢复正常、1例进步到D级，1例B级患者术后进步到C级。患者术前VAS评分为7～9分，平均8．1分，术后VAS评分为0～4分，平均为2．3分。X线片检查显示，所有存活的骨折患者的植骨部位已经融合，未见明显不稳定，未见内固定物松动以及断裂。结论 手术治疗AS合并脊柱骨折能够取得较好的治疗效果，值得在临床推广使用。

Objective] To explore the treatment method of ankylosing spondylitis combined with spinal fracture and its clinical efficacy .[Methods]Clinical data of 12 patients with ankylosing spondylitis and spinal fracture in our hospital from Jan .2010 to Dec .2012 were analyzed retrospectively .The 3 patients with lower cervical spinal fracture underwent the combination operation via anterior and posterior cervical vertebrae under general anesthesia .The 9 patients with thora‐columbar fracture underwent posterior incision and long segmental pedicle screw rod fixation .[Results]Among the 12 pa‐tients after rescue operation ,11 patients were treated successfully in which 1 patient died for invalid rescue ,and the mor‐tality rate was 8 .33% .More than 11 patients were followed up for 1 .5 years in which 1 patient died of respiratory fail‐ure ,and the 1 .5‐year survival rate was 90 .91% .The 10 patients received X‐ray examination 1 year after operation .Ac‐cording to Frankel classification ,neural function of 2 patients with grade D and 1 patient among 3 patients with grade C after operation recovered to the normal ,and 1 patient progressed to grade D ,and 1 patient with grade B progressed to grade C after operation .Preoperative VAS score was 7~9 points with an average of 8 .1 points ,and postoperative VAS score was 0~4 points with an average of 2 .3 points .X‐ray examination showed that bone graft site of all survival patients with fracture had fusion without obvious instability ,fixture loosening and breaking .[Conclusion] Surgical treatment of ankylosing spondylitis complicated with spinal fractures can achieve good efficacy ,so it is worthy of clinical promotion .