强直性脊柱炎并下颈椎骨折脱位手术治疗方法的选择  

Surgical treatment of ankylosing spondylitis with fracture and dislocation of lower cervical spine

作　　者：李志琳 张涛 杨成伟 高杰 窦强 蓝旭 LI Zhi-lin;ZHANG Tao;YANG Cheng-wei;GAO Jie;DOU Qiang;LAN Xu(Department of Spinal Surgeny,the 940th Hospital of Joint Logistics Support Force of Chinese People Liberation Army,Lanzhou,Gansu 730050,China)

机构地区：[1]解放军联勤保障部队第940医院脊柱外科

出　　处：《中国骨与关节损伤杂志》2020年第1期14-17,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨强直性脊柱炎并下颈椎骨折脱位手术方法的选择及治疗要点。方法回顾性分析自2015-03—2018-10诊治的7例强直性脊柱炎并下颈椎骨折脱位,4例采用单纯后路长节段固定融合术治疗(后路组),2例采用前后联合入路手术治疗(联合入路组),1例采用单纯前路植骨融合内固定术治疗(前路组)。结果后路组1例术后1周出现肺部并发症而死亡,其余6例获得随访,随访时间平均18.7(3~21)个月。术后切口均一期愈合,未出现感染。6例均在术后3~5个月获得骨性愈合,无内固定松动、断裂发生。后路组末次随访时脊髓神经功能ASIA分级:1例B级无改善,1例B级改善至D级,1例D级改善至E级。前路组末次随访时脊髓神经功能ASIA分级无改善(C级)。联合入路组末次随访时脊髓神经功能ASIA分级:1例B级无改善,1例C级改善至D级。结论强直性脊柱炎并下颈椎骨折脱位行手术治疗能够获得即刻稳定,一定程度上改善了患者脊髓神经功能,术前应根据患者骨折情况及原有畸形制定个体化手术方案。Objective To explore the choice of operative methods and the key points of treatment for the fracture and dislocation of lower cervical spine with ankylosing spondylitis.Methods Seven cases of ankylosing spondylitis with fracture and dislocation of the lower cervical spine treated from March 2015 to October 2018 were analyzed retrospectively.Four cases were treated with posterior approach and long segment fixation and fusion(posterior group),2 cases were treated with anterior and posterior approach(combined approach group),and 1 case was treated with anterior approach and long segment fusion and fixation(anterior group).Results One patient in the posterior group died of pulmonary complications 1 week after surgery,and the remaining 6 patients were followed up for an average of 18.7(3 to 21)months.The incisions healed in the first stage and no infection occurred.In 6 cases,bone healing was obtained 3 to 5 months after operation,and no internal fixation loosening or fracture occurred.The ASIA classification of spinal nerve function at the last follow-up of the posterior group:1 case of grade B did not improve,1 case of grade B improved to grade D,and 1 case of grade D improved to grade E.There was no improvement in spinal nerve function ASIA grading at the last follow-up of the anterior group(grade C).The ASIA classification of spinal nerve function at the last follow-up of the combined approach group:1 case of grade B had no improvement,and 1 case of grade C improved to grade D.Conclusion The surgical treatment of the fracture and dislocation of the lower cervical spine with ankylosing spondylitis can obtain immediate stability and improve the spinal nerve function of patients to some extent.Before the operation,the individualized operation plan should be made according to the patient’s condition and the original deformity.

关 键 词：强直性脊柱炎 下颈椎骨折 下颈椎脱位 外科手术 

分 类 号：R687.3[医药卫生—骨科学]