%0 Journal Article
%T 强直性脊柱炎合并脊柱骨折脱位的手术治疗
%A 汪雷
%A 宋跃明
%A 裴福兴
%A 刘立岷
%A 龚全
%A 孔清泉
%A 刘浩
%A 李涛
%A 曾建成
%J 华西医学
%P 1659-1662
%D 2011
%X 【】　目的　探讨强直性脊柱炎合并脊柱骨折脱位的临床特点及手术治疗效果。　方法　2009年10月-2010年6月，共收治6例强直性脊柱炎合并脊柱骨折脱位患者，其中男5例，女1例；年龄38～76岁，平均48.6岁。下颈椎骨折脱位3例，2例为颈5-6、1例颈6-7；胸腰段骨折脱位3例，为胸10-11、胸11-12、胸12-腰1各1例。6例患者中除1例术前神经功能为Frankel分级E级，其余5例均有不同程度的神经损伤。6例患者均行手术治疗，下颈椎骨折脱位采用前后联合入路复位及固定，胸腰段骨折脱位采用后路切开复位及椎弓根螺钉固定。术后观察手术节段内固定位置及骨融合情况，评估神经功能恢复情况，记录手术并发症。患者随访10~18个月，平均14.2个月。　结果　所有患者术后均未出现切口感染；脑脊液漏1例，换药对症处理3周后愈合。1例颈5-6骨折脱位患者行前路手术后第2天出现内固定移位，骨折椎再次脱位立即二次行前后联合入路复位固定术；3例术后神经功能由术前FrankelC级恢复至D级，2例无明显改善（术前均为A级），1例较术前加重（术前E级，术后为A级，经再次手术减压并康复治疗6个月后恢复至D级）。随访期间均达骨性融合，未出现内固定松动断裂移位现象。　结论　强直性脊柱炎脊柱骨折好发于下颈椎及胸腰段；对于下颈椎骨折脱位宜行前后联合入路复位固定，而胸腰段骨折宜行后路长节段椎弓根螺钉固定，术中应先充分减压后再精细复位，避免加重神经损伤。【Abstract】　Objective　Toexploretheclinicalcharacteristicsofspinalfractureanddislocationinankylosingspondylitis(AS)anditssurgicaltreatmenteffect.　Methods　FromOctober2009toJune2010,sixcaseswithspinalfracturesinASunderwentsurgicaltreatment.Therewere5malesand1femalewithanaverageageof48.6years(38-76yearsold).ThepreoperativeneuralfunctionofonecasewasgradeEaccordingtotheFrankelclassificationanddifferentdegreesofneuraldamagecouldbefoundinother5cases.Threecasesoflowercervicalfracturesunderwenttheoperationwithacombinedposterior-anteriorapproach.Threecasesofthoracolumbarfractureunderwenttheoperationwithposteriorapproach(posteriorreduction,fixationwithpediclescrewsandbonegraft).Thesituationofinternalfixationandbonefusionwasobservedafteroperation,theneuralfunctionhadbeenevaluatedandthepostoperativecomplicationswasrecorded.　Results　Allofthesixpatientswerefollowedupfor10-18months(mean14.2months).Therewasnoincisioninfection.Onepatientwithcerebrospinalfluidleakagewascuredwithconservativetreatmentforthreeweeks.OnepatientwithC5-6fractureanddislocationgotanteriorimplantlooseningandfracture-dislocationrecurrenceintheseconddayaftertheoperationandunderwentacombinedposterior-anterioroperationimmediately.Threecasesgotremarkableneuronalfunctionimprovementaftertheoperation.Twocaseswereremainprimarysituation.OnecasewasaggravatedfrompreoperativegradeEgradetopostoperativegradeAandrecoveredtogradeDafterrecoverytreatmentfor6months.Bonefusionwasachievedinallcases.Therewerenolooseningandbreakageofinternalfixationinthelaterfollowedup.　Conclusions　LowercervicalandthoracolumbarspinearetheusuallocationsoffractureinAS.Acombinedposterior-anteriorsurgicalapproachiseffectiveforlowercervicalfracturesandposteriorlong-segmentalreductionandthefixationisadesiredselectforthoracolumbarfractures.
%K 强直性脊柱炎
%K 骨折
%K 脱位
%K 手术治疗
%U http://www.hxyxqk.com.cn/oa/DArticle.aspx?type=view&id=201111020