长节段固定强直性脊柱病过伸型胸腰椎骨折

Long-segment fixation combined with interfragmentary bone grafting for hyperextension thoracolumbar fractures secondary to ankylosing spinal disease

[目的]观察后路长节段固定联合骨折断端间植骨融合术治疗强直性脊柱病合并过伸型胸腰椎骨折的疗效。[方法]回顾性分析2012.01~2016.12本院采用后路长节段固定联合骨折断端间植骨融合术治疗强直性脊柱病合并过伸型胸腰椎骨折28例患者。总结围手术期、随访与影像资料。[结果] 28例均顺利完成手术,无严重并发症。随时间推移,患者VAS和ODI评分显著减少(P<0.05),而神经功能ASIA评级显著改善(P<0.05)。影像方面,28例患者术后影像显示骨折复位良好,内固定物位置良好。其中,20例患者于损伤前影像确诊为强直性脊柱病并脊柱后凸畸形;与损伤前相比,术后即刻局部后凸角(LKA)显著减少(P<0.05),而椎体前缘高度(AVH)、椎体后缘高度(PVH)显著增加(P<0.05);末次随访与术后即刻比较,LKA、AVH、PVH均无显著改变(P>0.05)。末次随访时,28例患者均达到BridwellⅠ级融合,均未出现内固定松动、断钉断棒。[结论]采用后路长节段固定联合骨折端植骨融合术治疗强直性脊柱病合并过伸型胸腰椎骨折安全及可行,并可在一定程度上矫正后凸畸形。

[Objective] To evaluate the clinical outcomes of long-segment fixation combined with interfragmentary bone grafting for hyperextension thoracolumbar fractures secondary to ankylosing spinal disease. [Methods] A retrospective study was conducted on 28 patients who underwent long-segment pedicle screw-rod fixation combined with interfragmentary bone grafting for hyperextension thoracolumbar fractures secondary to ankylosing spinal disease in our hospital from January 2012 to December 2016. The perioperative, follow-up and radiographic documents were summarized. [Results] All the 28 patients had surgical procedures performed successfully without serious complications. As time went, the VAS and ODI scores significantly decreased(P<0.05), while the ASIA neurological function rank significantly upgraded(P<0.05). With regard to imaging assessment, all the 28 patients got satisfactory fracture reduction immediately after operation, with proper implants placed. Of them,20 patients had pre-injury radiographic films, which revealed definitive diagnosis of ankylosing spinal disease accompanied with kyphosis. After operation the local kyphotic angle(LKA) significantly decreased(P<0.05), whereas the anterior vertebral height(AVH) and the posterior vertebral height(PVH) significantly increased(P<0.05), compared with those before injuries.However, the LKA, AVH and PVH remained unchanged at the latest follow-up in contrast to those immediately after operation(P>0.05). To the latest follow-up, all the 28 patients got the fractured segment fusion in Bridwell grade Ⅰ, without loosening or breaking of the implants. [Conclusion] The long-segment fixation combined with interfragmentary bone grafting is safe and effective treatment for hyperextension thoracolumbar fractures secondary to ankylosing spinal disease, with advantage of kyphotic correction in some extent.