前后路联合手术治疗强直性脊柱炎合并颈椎骨折的临床效果分析

Clinical analysis of combined anterior and posterior surgery for ankylosing spondylitis combined with cervical spine fracture

目的:探讨强直性脊柱炎合并颈椎骨折的临床特点,分析前后路联合手术的融合率及临床疗效。方法:回顾性分析手术治疗的25例累及颈椎的强直性脊柱炎合并颈椎骨折或脱位的临床资料,均给予前后路联合手术治疗,采用α角对术后脊柱融合状况进行研究,通过美国脊柱损伤协会(ASIA)对患者的手术前后的神经功能进行评价,并对手术相关问题进行描述性研究分析。结果:随访的时间为15～25个月,平均随访时间为18. 6个月,患者进行前后联合手术的平均治疗时间为3. 6 h(2. 5～5. 9 h),术中平均出血量2 000 m L(1 760～2 390mL),所有手术患者的α角为0°～1. 3°,术后脊柱融合相对较好。对于ASIA分级,术前4例A级,术后仍均为A级,无明显变化;术前10例B级,术后7例C级,3例D级;术前7例C级,术后5例D级,2例E级;术前4例D级,术后均恢复至E级。术后出现1例脑脊液漏,1例食管瘘,1例声音嘶哑,1例肺不张、1例气胸、1例伤口内积血,1例伤口内积液,给予及时对症治疗均逐渐恢复。结论:前后路联合手术治疗强直性脊柱炎合并颈椎骨折降低术后α角,改善植骨融合和脊髓神经功能状况,减少术后并发症,效果显著。

Objective： To investigate the clinical features of ankylosing spondylitis combined with cervical fractures and analyze the fusion rate and clinical efficacy of anterior and posterior surgery. Methods： We retrospectively analyzed the clinical data of 25 cases of ankylosing spondylitis involving the cervical spine with cervical fracture or dislocation after surgical treatment.All patients were given anterior and posterior surgery.The angle of postoperative spinal fusion was studied by α angle,and the neurological function of the patient before and after surgery was evaluated by the American Association of Spinal Injury （ASIA）,and a descriptive analysis was performed on the related problems of surgery. Results： The follow-up time was 15-25 months,and the average follow-up time was 18.6 months.The average treatment time of the patients before and after combined surgery was 3.6 h （2.5-5.9 h）.The average intraoperative blood loss was 2 000 mL（1 760-2 390 mL）.The α angle of all surgical patients was 0°-1.3°,and postoperative spinal fusion was relatively good.For ASIA grading,4 cases were grade A before surgery,and all were still grade A after surgery.There were no significant changes in the ASIA,10 cases were of preoperative B grade,7 cases were postoperative C grade,and 3 cases were grade D,7 patients were preoperatively grade C,5 patients were grade D,and 2 patients were grade E,4 patients were grade D before surgery and all recovered to grade E after surgery.1 case of cerebrospinal fluid leakage,1 case of esophageal fistula,1 case of hoarseness,1 case of atelectasis,1 case of pneumothorax,1 case of blood accumulation in the wound,1 case of wound fluid accumulation,and timely symptomatic treatment were gradually restored. Conclusion： Anterior and posterior approach combined surgery for ankylosing spondylitis combined with cervical spine fracture reduces postoperative α angle,improves bone graft fusion and spinal nerve function,reduces postoperative complications,and the effect is significant.