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华西医学  2011 

强直性脊柱炎合并脊柱骨折脱位的手术治疗

, PP. 1659-1662

Keywords: 强直性脊柱炎,骨折,脱位,手术治疗

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Abstract:

【】 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.

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