外科长节段固定后外侧植骨融合治疗强直性脊柱炎骨折/脱位  

Long Segmental Fixation and Bone Graft in the Treatment of Thoracolumbar Vertebral Fracture and Dislocation Patients with Ankylosing Spondylitis

作　　者：颜廷振[1] 魏彦春[1] 伊广坤 

机构地区：[1]山东济宁市第一人民医院脊柱外科,山东济宁272111

出　　处：《实用骨科杂志》2014年第11期969-972,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨一期后路USS系统长节段固定加后外侧植骨融合治疗强直性脊柱炎胸腰椎骨折脱位的疗效。方法 2011年1月至2012年7月我科收治17例强直性脊柱炎胸腰椎骨折脱位的患者,经临床症状结合外伤史及影像学检查确诊,其中9例患者合并不同程度的脊髓损害,采用一期后路USS钉棒系统长节段固定加植骨融合治疗方法治疗,观察患者疼痛视觉模拟评分（visual analogue scale,VAS）、神经功能恢复及临床骨愈合情况,评价治疗效果,并记录手术时间、术中出血量及手术并发症。结果手术时间为160-250 min,术中失血量300-700 mL。随访3-6个月（平均4.5个月）,所有患者疼痛较术前明显缓解。围手术期无死亡病例,未发生伤口感染,并发肺炎2例,8例神经损伤患者,神经系统功能有不同程度恢复。所有患者骨折部位均达到临床骨性愈合,脊柱序列稳定,随访期内未发生钉棒断裂、松动等并发症。结论采用USS钉棒系统长节段固定加后外侧植骨融合方式可有效提高强直性脊柱炎胸腰椎骨折脱位固定的可靠性及稳定性,提高植骨融合率,明显缓解患者疼痛,并可不同程度改善患者神经损伤功能。Objective To investigate the effects of posterior long segmental fixation used USS system and bone graft in the treatment of thoracolumbar vertebral fracture and dislocation patients with ankylosing spondylitis.Methods Form January2011 to July 2012,17 ankylosing spondylitis cases with thoracolumbar vertebral fracture and dislocation were confirmed by clinical symptoms,images（X-ray and CT,MRI） in our department of,all patients had a history of trauma.9 patients had varying degrees of neurological dysfunction.All patients accepted surgical treatment with posterior long segmental fixation used USS system and bone graft.The operation time,blood lose and postoperative complications was recorded in this study.The clinical outcomes were evaluated by VSA scores,neurological function recovery and clinical bone fusion.Results The operation time was 160 - 250 min,the blood loss was 300 - 700 mL.All of the patients were followed up for 3 - 6 months（mean 4.5months）,and the symptom of thoracolumbar pain significantly were relieved,there was no incision infection and patient die,2patients had pneumonia during perioperative.8 cases of which had neurological dysfunction got different degrees of improvement after the operation.Clinical evidence of bone fusion was observed in all of the 17 patients.There were no loosening and breakage of internal fixation in the later followed up.Conclusion Posterior long segmental fixation used USS system and bone graft can effectively improve the reliability and stability of the fixation in AS patients with thoracolumbar vertebral fracture and dislocation.It can reduce pain and increase the probability of bone fusion in AS patients significantly,and also it can improve the patients＇ neurological dysfunction.

关 键 词：强直性脊柱炎 骨折脱位 长节段固定 植骨融合 

分 类 号：R683.2[医药卫生—骨科学]