强直性脊柱炎患者颈椎新鲜骨折的临床特征及术式选择

Fresh fracture of the cervical spine in ankylosing spondylitis: clinical characteristics and surgical strategy

中文关键词:  强直性脊柱炎  颈椎骨折  手术治疗

英文关键词:Ankylosing spondylitis  Cervical spine fracture  Surgical strategy

中文摘要:

  【摘要】 目的：探讨强直性脊柱炎（AS）患者颈椎新鲜骨折的临床特征及手术策略。方法：回顾性分析2002年2月~2014年10月我科收治的15例AS颈椎新鲜骨折患者的临床资料，其中男14例，女1例，年龄36~76岁，平均49.7±10.8岁。13例有明确外伤史，其中4例为高能量损伤；经椎间隙和经椎体骨折分别为8例和7例，14例累及C5~C7节段；12例（80%）伴神经功能损害。12例接受手术治疗，7例前柱广泛破坏者行前路椎间盘切除或椎体次全切除、内固定植骨融合术；3例脊髓后方受压、前柱轴向承载功能保持良好的患者行后路椎板减压内固定融合术；2例严重骨折脱位不稳定患者行前后路联合手术。采用ASIA分级评估患者手术前后神经功能状态，摄颈椎X线片观察植骨融合情况。结果：除3例未手术患者外，余患者均获得随访，随访时间3~60个月（20.0±18.8个月），除1例术前ASIA A级及2例ASIA D级患者外，其余患者术后神经功能均获明显改善，末次随访时骨折部位骨性融合。围手术期并发症包括脑脊液漏1例，喉返神经损伤1例，前路术后切口深部感染1例。随访中无骨折不愈合、假关节形成及内固定失败。结论：AS颈椎新鲜骨折好发于下颈椎，伤后神经系统并发症发生率较高，应积极手术治疗稳定脊柱；前柱明显破坏患者选择单纯前路手术，前柱轴向承载功能尚可者行单纯后路手术，严重颈椎骨折脱位患者应行前后路联合手术。

英文摘要:

  【Abstract】 Objectives: To explore the clinical features and the optimal surgical strategies of the cervical spine fresh fracture complicated with ankylosing spondylitis(AS). Methods: Between February 2002 and October 2014, 15 AS patients with concomitant fresh fracture of the cervical spine treated in our institution were included in this study. There were 14 males and 1 female with a mean age of 49.7±10.8 years(range, 36-76 years). Among them 13 cases with trauma history, only 4 cases sustained high energy injury. Most fractures located at C5-C7(14 cases), 8 transvertebral and 7 transdiscal injuries were noted. Neurological compromise accounted for 12(80%) cases. 12 patients received surgical treatment, consisting anterior discectomy/corpectomy and fusion in 7 cases, posterior long-segment fixation and fusion in 3 cases, and combined anterior and posterior approach in 2 cases. Pre- and post-operative neurologic functions were evaluated by ASIA grade, and fusion rate was assessed by X-ray during follow-up. Results: Except that 3 patients did not undertake surgical treatment, all the other patients were followed up for an average of 20.0±18.8 months(range, 3-60 months). Except for 1 ASIA grade A and 2 ASIA grade D patients, neurological function improved significantly after surgery. Solid fusion was observed in all patients at final follow-up. Perioperative complications included postoperative cerebrospinal fluid leakage in 1 case, recurrent nerve injury in 1 case and deep wound infection following anterior approach in 1 case. No nonunion, pseudarthrosis or implant failure was noted. Conclusions: Subaxial cervical spine injury is common in AS patients, and the three-column involvement makes the fracture extremely unstable which may often lead to neurological deficits. Anterior stabilization is effective in those with obvious anterior column defects. For AS patients with sufficiently stable anterior column, posterior fixation should be adopted. And a combined anterior-posterior approach should be applied for severe fracture-dislocation of the cervical spine.