弥漫性特发性骨肥厚症合并胸腰椎骨折14例

Clinical Report of 14 Cases for Diffuse Idiopathic Skeletal Hyperostosis Combined with Thoracolumbar Fractures

目的:分析弥漫性特发性骨肥厚症(DISH)合并胸腰椎骨折的病例特点。方法:回顾性分析2018年1月至2022年10月诊治的14例弥漫性特发性骨肥厚症合并胸腰椎骨折病例资料,根据X线片、CT和MRI评估脊柱损伤类型:前柱经椎间盘损伤型骨折5例,经骨损伤型骨折3例,混合型骨折3例,不稳定型骨折3例。患者均行后入路胸腰椎骨折切开复位椎弓根螺钉内固定手术治疗。比较患者手术时间、术中出血量,术前及术后3个月、末次随访时疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、日本骨科学会(JOA)评分及美国脊柱损伤协会(ASIA)脊髓损伤分级评价其疗效。结果:患者的手术时间、术中出血量差异均无统计学意义(P>0.05)。患者在术后3个月与术前相比、末次随访时与术后3个月相比,腰痛VAS评分、腿痛VAS评分、ODI评分均明显降低,差异有统计学意义(P<0.05);JOA评分明显升高,差异有统计学意义(P<0.05)。患者的ASIA分级为术前C级1例,D级13例;末次随访时D级3例,E级11例;神经功能较术前改善明显。结论:弥漫性特发性骨肥厚症患者因其疾病特点更容易出现脊柱骨折,临床医生要将其与其他疾病进行鉴别并合理诊治,避免出现误诊漏诊。

Objective:To analyze the characteristics of cases with diffuse idiopathic skeletal hyperostosis(DISH)combined with thoracolumbar vertebral fractures.Methods:A retrospective analysis was conducted on 14 cases of DISH combined with thoracolumbar vertebral fractures treated from January 2018 to October 2022.The spinal injury types were evaluated based on X-rays,CT,and MRI with anterior column through intervertebral disc injury fractures in 5 cases,through bone injury fractures in 3 cases,mixed fractures in 3 cases,and unstable fractures in 3 cases.All patients underwent posterior approach thoracolumbar vertebral fracture open reduction and internal fixation with pedicle screw surgery.Comparison of surgical time,intraoperative blood loss,preoperative,postoperative 3 months,and last follow-up visual analogue scale(VAS)for pain,Oswestry disability index(ODI),Japanese orthopedic association(JOA)scores,and American spinal injury association(ASIA)spinal cord injury grading were used to evaluate the efficacy.Results:There were no significant differences in surgical time,intraoperative blood loss among patients(P>0.05).Compared with preoperative values,at postoperative 3 months and last follow-up,lumbar pain VAS scores,leg pain VAS scores,and ODI significantly decreased,showing statistical significance(P<0.05).JOA scores significantly increased at postoperative 3 months and last follow-up,demonstrating statistical significance(P<0.05).ASIA grades of patients were 1 case of grade C and 13 cases of grade D preoperatively.At the last follow-up,3 cases were grade D and 11 cases were grade E,indicating significant improvement in neurological function compared to preoperative status.Conclusion:Due to the characteristic features of DISH,patients are more prone to vertebral fractures.Clinicians should differentiate it from other diseases and provide rational diagnosis and treatment to avoid misdiagnosis and missed diagnosis.