强直性脊柱炎颈椎骨折手术治疗的特点  

Surgical Treatment of Cervical Spine Fracture with Ankylosing Spondylitis

作　　者：左春光 张军[1] 王新虎[1] 刘继军[1] 王建顺[1] 

机构地区：[1]陕西省宝鸡市中心医院脊柱外科,陕西宝鸡721008

出　　处：《实用骨科杂志》2011年第12期1081-1083,共3页Journal of Practical Orthopaedics

摘　　要：目的探讨强直性脊柱炎颈椎骨折或合并脱位的特点和外科治疗过程中应该注意的问题。方法回顾性分析1998年6月至2010年10月手术治疗累及颈椎的强直性脊柱炎合并颈椎骨折或脱位13例,采用美国脊柱损伤学会神经功能障碍评分评价神经功能,术前A级2例,B级6例,C级3例,D级2例。手术方式采用前路、后路、前后联合入路。结果应用前路3例,后路4例,前后联合入路6例。术后神经功能除2例A级随访无改善外,其余11例均有不同程度恢复。平均随访3.7年,术后平均3.5个月植骨获得融合,无内固定失败。围手术期并发症1例为食管瘘,无远期并发症。结论强直性脊柱炎累及颈椎时颈椎发生骨折和脱位的可能性较大,多数为不稳定型损伤,骨折可损伤食管引起食管瘘。早期减压植骨融合内固定、有效解除脊髓压迫是强直性脊柱炎颈椎骨折或脱位的合理治疗方式。Objective To discuss the characteristics of surgical treatment of cervical fracture-dislocation with ankylosing spondylitis（AS）.Methods Thirteen AS patients with traumatic cervical fracture-dislocation were treated from June 1998 to Oct 2010,three were 2 cases of Grade A,6 cases of Grade B,3 cases of Grade C and 2 cases of Grade D.All patients underwent surgical procedures by anterior,posterior or combined approach.Results There were 3 anterior procedures,4 posterior procedures and 6 anterior-posterior procedures.There were some extent neurological improvement in 11 incompletely paraplegic patients,and no improvement in 2 complete paraplegia patients.The follow-up period was 3.7 years in average and the bone fusion was 3.5 months.There were one complication of esophageal fistula occurred during the perioperation.Conclusion This study suggests that most cervical fracture-dislocation with AS are extremely unstable or even esophageal fistula occur which require operations.Early decompression and fusion with internalfixation can achieve good spinal myeloid functional recovery.

关 键 词：强直性脊柱炎 颈椎 骨折 手术 

分 类 号：R593.23[医药卫生—内科学]