【摘要】 目的 探討強直性脊柱炎合并脊柱骨折脫位的臨床特點及手術治療效果。 方法 2009年10月-2010年6月，共收治6例強直性脊柱炎合并脊柱骨折脫位患者，其中男5例，女1例；年齡38～76歲，平均48.6歲。下頸椎骨折脫位3例，2例為頸5-6、1例頸6-7；胸腰段骨折脫位3例，為胸10-11、胸11-12、胸12-腰1各1例。6例患者中除1例術前神經功能為Frankel分級 E級，其余5例均有不同程度的神經損傷。6例患者均行手術治療，下頸椎骨折脫位采用前后聯合入路復位及固定，胸腰段骨折脫位采用后路切開復位及椎弓根螺釘固定。術后觀察手術節段內固定位置及骨融合情況，評估神經功能恢復情況，記錄手術并發癥。患者隨訪10~18個月，平均14.2個月。 結果 所有患者術后均未出現切口感染；腦脊液漏1例，換藥對癥處理3周后愈合。1例頸5-6骨折脫位患者行前路手術后第2天出現內固定移位，骨折椎再次脫位立即二次行前后聯合入路復位固定術；3例術后神經功能由術前Frankel C級恢復至D級，2例無明顯改善（術前均為A級），1例較術前加重（術前E級，術后為A級，經再次手術減壓并康復治療6個月后恢復至D級）。隨訪期間均達骨性融合，未出現內固定松動斷裂移位現象。 結論 強直性脊柱炎脊柱骨折好發于下頸椎及胸腰段；對于下頸椎骨折脫位宜行前后聯合入路復位固定，而胸腰段骨折宜行后路長節段椎弓根螺釘固定，術中應先充分減壓后再精細復位，避免加重神經損傷。
【Abstract】 Objective To explore the clinical characteristics of spinal fracture and dislocation in ankylosing spondylitis (AS) and its surgical treatment effect. Methods From October 2009 to June 2010, six cases with spinal fractures in AS underwent surgical treatment. There were 5 males and 1 female with an average age of 48.6 years (38-76 years old). The preoperative neural function of one case was grade E according to the Frankel classification and different degrees of neural damage could be found in other 5 cases. Three cases of lower cervical fractures underwent the operation with a combined posterior-anterior approach. Three cases of thoracolumbar fracture underwent the operation with posterior approach (posterior reduction, fixation with pedicle screws and bone graft). The situation of internal fixation and bone fusion was observed after operation, the neural function had been evaluated and the postoperative complications was recorded. Results All of the six patients were followed up for 10-18 months (mean 14.2 months). There was no incision infection. One patient with cerebrospinal fluid leakage was cured with conservative treatment for three weeks. One patient with C5-6 fracture and dislocation got anterior implant loosening and fracture-dislocation recurrence in the second day after the operation and underwent a combined posterior-anterior operation immediately. Three cases got remarkable neuronal function improvement after the operation. Two cases were remain primary situation. One case was aggravated from preoperative grade E grade to postoperative grade A and recovered to grade D after recovery treatment for 6 months. Bone fusion was achieved in all cases. There were no loosening and breakage of internal fixation in the later followed up. Conclusions Lower cervical and thoracolumbar spine are the usual locations of fracture in AS. A combined posterior-anterior surgical approach is effective for lower cervical fractures and posterior long-segmental reduction and the fixation is a desired select for thoracolumbar fractures.
Citation： WANG Lei,SONG Yueming,PEI Fuxing,LIU Liming,GONG Quan,KONG Qingquan,LIU Hao,LI Tao,ZENG Jiancheng. Surgical Management of Spine Fracture and Dislocation in Ankylosing Spondylitis. West China Medical Journal, 2011, 26(11): 1659-1662. doi: Copy
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