强直性脊柱炎的脊柱手术原因分析

Cause analysis of spinal surgery in ankylosing spondylitis

目的:了解强直性脊柱炎(ankylosing spondylitis,AS)常见的脊柱手术原因,以便风湿科医师能够更好地为患者制定合理、有效的治疗方案,并普及患者教育。方法:回顾性收集北京大学第三医院自2007年1月至2013年7月在骨科住院并接受脊柱手术的79例AS患者的住院资料,其中男72例,女7例,根据患者手术原因进行总结分析。结果:手术部位以颈椎居多,为59例(74.7%),其他依次为胸腰椎、胸椎、颈胸椎及腰椎。常见的AS脊柱手术原因为骨折、脱位等不稳定因素(53.2%),其中骨折患者27例,多数为创伤所致,其次为脊髓或神经根压迫(34.1%),正畸(12.7%)并不是主要的手术原因。颈椎手术以颈椎病(25例)最多见,其次为颈椎骨折(22例),以颈7椎体骨折最多(8例),因颈椎脱位而手术的病例居第3位(10例)。颈椎手术中寰枢椎病变较常见(13例),主要病因为脱位、半脱位或不稳定,其次为骨折,寰枢椎手术患者的年龄及病程小于其他部位的颈椎手术患者。胸腰椎手术以胸腰椎后凸正畸手术最常见(10例),其次是骨折(6例),多发生于胸11~12椎体。根据入院时间将接受脊柱手术的AS患者按年份进行统计,2007—2008年最多为34例,2009—2010年为26例,2011—2013年7月仅19例,接受手术人数呈逐年递减趋势。结论:AS脊柱手术节段以颈椎为主,寰枢椎病变并不少见。AS脊柱手术的原因以骨折等脊柱不稳定病变和压迫症状为主,创伤因素也占相当比例。虽然接受脊柱手术的AS患者正逐年减少,但风湿科医师仍需加强对AS患者的早期诊疗及规范患者教育。

Objective: To investigate the common cause of spinal surgery in ankylosing spondylitis( AS) and to develop reasonable and effective treatment programs for rhematologists. Methods: In this study,79 AS patients( 72 males,7 females) hospitalized in the Department of Orthopedic and received spinal surgery in Peking University Third Hospital from January 2007 to July 2013 were investigated retrospectively. The causes of the spinal surgery were analyzed. Results: The majority of the surgery were of cervical vertebra surgery for 59 cases( 74. 7%),followed by the thoracolumbar vertebra,thoracic vertebra,cervicothoracic vertebra,and lumbar vertebra. The common causes of AS spinal surgery were instability( 53. 2%) including fracture and dislocation caused by trauma mostly,followed by compression symptoms( 34. 1%). However,the orthopaedic surgery( 12. 7%) was not the predominant surgery causes. The most common cause of cervical surgery was cervical spondylosis( 25 cases),followed by cervical fracture( 22 cases) and cervical dislocation( 10 cases). For cervical fracture,the most common site was C7( 8 cases). Atlanto-axial vertebral lesions( 13 cases) induced by dislocation,subluxation,instability and fracture were common in cervical vertebra surgery. The age and disease duration of atlantoaxial surgical patient's were less than other parts of the cervical surgery. Thoracolumbar vertebra surgery included thoracolumbar kyphosis orthopaedic surgery( 10 cases),and fractures( 6 cases),which mainly occurred in T11-12 vertebrae. According to the time of admission for surgery,the cases of AS that received spinal surgery were 34 from 2007 to 2008. The number of the cases that accepted the surgery decreased gradually year by year. Conclusion: The majority surgery section was cervical vertebra,and atlanto-axial vertebral lesions were not rare as we thought. The main etiology of spinal surgery for AS patients was instability,e. g. fracture and compression symptoms. Of course,trauma accounted for the relative percentage of this phetonomenon. Although,the annual number of patients who receives spinal surgery is decreasing,to go to make early diagnosis and treatment,and to standardize patient education for AS patients are still important.