强直性脊柱炎合并胸腰椎骨折的手术方式选择

Choice of surgical methods for ankylosing spondylitis combined with thoracolumbar fractures

目的分析不同手术方式治疗强直性脊柱炎合并胸腰椎骨折的临床疗效。方法回顾性分析自2016-02—2017-10诊治51例强直性脊柱炎合并胸腰椎骨折,8例单纯椎体压缩骨折采用经皮椎体成形术(Percutaneous vertebroplasty,PVP)治疗(A组);18例合并轻度、中度骨质疏松症的椎体三柱骨折采用椎弓根钉内固定治疗(B组);25例合并重度骨质疏松症的椎体压缩骨折采用椎弓根钉内固定联合PVP治疗(C组)。比较3组术前与术后1、2、6周强直性脊柱炎评分,比较3组术前与末次随访时伤椎前缘高度。结果 3组均顺利完成手术,随访时间1~6个月,平均3.2个月。51例均获得骨性愈合,未出现骨折不愈合、断钉、断棒等并发症。3组术后1、2、6周强直性脊柱炎评分均较术前提高,差异有统计学意义(P<0.05);末次随访时伤椎前缘高度较术前明显减小,差异有统计学意义(P<0.05)。结论强直性脊柱炎合并胸腰椎骨折需要早期诊断并根据患者情况选择手术方式,PVP与椎弓根钉内固定治疗均能取得满意的疗效。

Objective To analyze the clinical efficacy of different surgical methods in the treatment of ankylosing spondylitis combined with thoracolumbar fractures.Methods Fifty-one cases of ankylosing spondylitis with thoracolumbar fractures from February 2016 to October 2017 were retrospectively analyzed. Eight cases of simple vertebral compression fractures were treated with percutaneous vertebroplasty(PVP)(group A), 18 cases of vertebral three-column fractures with mild and moderate osteoporosis were treated with pedicle screw internal fixation(group B), and 25 cases of vertebral compression fractures with severe osteoporosis were treated with pedicles nail internal fixation combined with PVP therapy(group C). The ankylosing spondylitis scores were compared between the 3 groups before operation and 1, 2, and 6 weeks after operation, and the height of the anterior edge of the injured vertebrae was compared between the 3 groups before operation and at the last follow-up.Results All 3 groups completed the operation successfully. The follow-up time was 1 to 6 months, with an average of 3.2 months. All fractures achieved bone union, and there were no complications such as nonunion of fractures, broken nails, and broken rods. The scores of ankylosing spondylitis in the 3 groups at 1, 2, and 6 weeks after surgery were all higher than those before surgery, and the difference was statistically significant(P<0.05);at the last follow-up, the height of the anterior edge of the injured vertebra was significantly lower than that before surgery, and the difference was statistically significant(P<0.05).Conclusion spondylitis combined with thoracolumbar fractures requires early diagnosis and selection of surgical approaches according to the patient’s condition. Both PVP and pedicle screw internal fixation can achieve satisfactory results.