强直性脊柱炎并颈椎骨折的手术策略

Surgical strategy for ankylosing spondylitis with cervical fracture

目的探讨强直性脊柱炎(AS)并颈椎骨折的临床特点及手术策略。方法回顾性分析2013年3月—2018年12月山东省立医院收治的18例强直性脊柱炎并颈椎骨患者的临床资料,男性15例,女性3例;年龄37~63岁,平均48.2岁;AS病程13~36年,平均17.3年;C 2~3骨折2例,C 4~5骨折2例,C 5~6骨折12例,C 6~7骨折2例;伴明显骨折脱位7例,无脱位11例。13例采取颈椎后路手术,4例行颈椎后前路手术,1例前后路手术。所有患者术前完善颈椎DR、CT、MR检查,术后1周内、3个月、半年分别完善影像学复查;所有患者术前术后进行美国脊髓损伤协会(ASIA)评分。结果所有患者术后1个月开始随访,随访时长12~24个月,平均19.4个月。影像学检查骨折复位良好,骨折愈合平均时间为3.8个月,愈合率100%。17例患者术后内固定物无松动、脱出及移位(94.4%),仅1例患者前路手术后内固定物松动移位后再行翻修手术(5.6%)。神经功能在术后均获得不同程度恢复。结论采用单纯后路椎弓根螺钉技术或者后路手术联合前路等操作治疗强直性脊柱炎合并颈椎骨折患者,可以获得坚强内固定,重建颈椎稳定性,保证复位、促进骨折愈合,神经损伤等相关并发症发生较少。

Objective To investigate the clinical features and surgical strategies of cervical vertebral fracture in patients with ankylosing spondylitis.Methods The clinical data of 18 patients with ankylosing spondylitis complicated with cervical spine fracture was retrospectively analyzed,who were admitted in our hospital from Mar.2013 to Dec.2018.There were 15 males and 3 females,with an average age of 48.2 years(mean 37-63).The duration of AS ranged from 13 to 36 years,with an average of 17.3 years.There were 2 cases of C 2-3 fractures,2 cases of C 4-5 fractures,12 cases of C 5-6 fractures and 2 cases of C 6-7 fractures.There were 7 cases with obvious fracture dislocation and 11 cases without dislocation.Thirteen cases underwent decompression and fusion with posterior cervical pedicle screw,four cases underwent decompression and fusion with posterior cervical pedicle screw,and one case underwent anterior and posterior cervical pedicle screw.Preoperative DR,CT and MR examinations of cervical spine were performed for all patients,and imaging reexamination was completed within one week,three months and half a year after surgery.All patients received ASIA score before and after surgery.Results All patients were followed up 1 month after operation.The follow-up period was 12-24 months,with an average of 19.4 months.Fracture reduction result was good on imaging examination.The average time of fracture healing was 3.8 months,and the healing rate was 100%.There was no loosening,prolapse or displacement of internal fixation in 17 patients(94.4%).After anterior surgery,the internal fixator was displaced in one patient,who then underwent anterior revision surgery(5.6%).Neurological function of the patients recovered after operation.Conclusion Using single posterior pedicle screw technique or posterior surgery combined with anterior approach to treat patients with ankylosing spondylitis combined with cervical spine fractures can obtain strong internal fixation,reconstruct cervical stability,ensure reduction,promote fracture healing,and have less complications such as nerve damage.