强直性脊柱炎合并Andersson损害的系统评价

Andersson lesion in ankylosing spondylitis： a systematic review

目的系统评价AS合并Andersson损害（AL）的临床特点。方法以＂强直性脊柱炎＂ ＂Andersson＂ ＂椎体病变＂ ＂椎间盘椎体病变＂ ＂椎间盘炎＂ ＂破坏性椎体病变＂ ＂假关节＂ ＂应力性骨折＂等主题词联合检索PubMed、EMBASE、Cochrane Library、知网、万方等中英文数据库，收集1937年1月至2016年12月关于AS合并Andersson病变相关性的文献。按纳入与排除标准进行文献筛选及资料提取。采用SPSS 23.0统计学软件进行处理，行t检验。结果共检索57篇文献，阅读文摘和标题，初步排除14篇，其中综述12篇、Meta分析2篇。经阅读全文评估后，排除不相关文献9篇、误诊病例文献2篇、不满足纳入条件文献14篇、PsA合并Andersson损害2篇、重复发表论文1篇，最终共纳入15篇文献，主要为个案报道及个别小样本报道，共有47例病例符合选择标准，其中，男性38例（81%），女性9例（19%），平均（45±12）岁，诊断AS到合并AL病程为0.5~41年，平均（11±7）年；其中24例（51%）有明确外伤史，20例（43%）存在后凸畸形，其以胸腰段（15例）最为常见，不同部位差异均有统计学意义（P〈0.05）；4例（9%）误诊为结核病；术前术后ESR和CRP比较差异均无统计学意义（P〉0.05）；主要经影像学确诊（42例），MRI为公认的最好方法；40例（85%）行手术治疗，主要为后路经椎弓根楔形切除截骨或前后路联合手术入路，恢复矢状面AS脊柱的平衡，其余7例（15%）予免疫抑制保守治疗。结论确诊AS合并AL实验室检查有限，主要靠MRI确诊，经椎弓根及椎间盘截骨技术可获得满意的矫形效果及良好的融合，是治疗AS合并AL的有效方法。

ObjectiveTo investigate the clinical features of Andersson lesion （AL） in ankylosing spondylitis （AS）.MethodsA comprehensive search was performed for all scientific literatures using search string ＂ankylosing spondylitis＂ ＂Andersson lesion＂ ＂vertebral lesion＂ ＂destructive lesion＂ ＂spondylodiscitis＂ ＂discitis＂ ＂pseudarthrosis＂ or ＂stress fracture＂ published between January 1937 and December 2016. Literature screening and data extraction were done according to the inclusion and exclusion criteria. Statistical Product and Service Solutions （SPSS） 23.0 software was used for statistical analysis. Data was analyzed by one sample t test and paired sample t test.ResultsFifteen papers were selected after literature review （57） and 47 cases met the selection criteria finally. Male patients was 38（81%） and female was 9（19%）, and their average age was （45±12） years old. The disease duration was defined as the time range from the definite diagnosis of AS to the onset of AL and it was between 0.5 to 41years with the average of （11±7） years. Twenty-four cases （51%） had a clear history of trauma. Twenty cases （43%） performed kyphosis in which thoracolumbar segments （15 cases） was the most commonly involvedand the difference was statistically significant （P〈0.05）. Four cases （9%） were misdiagnosed as tuberculosis. There was no statistically different for preoperative and postoperative ESR and CRP （P〉0.05）. The above cases were confirmed by imageology （42 cases） and magnetic resonance imaging （MRI） was the best method. Forrty cases （85%） were treated by surgery and the other 7 cases （15%） were treated with immunosuppressive therapy.ConclusionAS patients with AL are always associated with trauma and diagnosed by means of MRI. Orthopedic effect and good fusion can be obtained by pedicle and intervertebral disc osteotomy which is an effective method for the treatment of AS with AL.