一期后前路联合手术治疗强直性脊柱炎患者颈椎骨折脱位伴脊髓损伤疗效分析  

One stage posterior anterior approach combined with operation for the treatment of ankylosing spondylitis with cervical fracture dislocation and spinal cord injury

作　　者：肖伟[1] 赵清斌 殷剑[1] 车立新[1] 孙俊刚[1] XIAO Wei;ZHAO Qing-bin;YIN Jian;CHE Li-xin;SUN Jun-gang(Orthopaedic Centre of Xinjiang Uygur Autonomous Region People′s Hospital,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院骨科中心,新疆乌鲁木齐830001

出　　处：《创伤与急危重病医学》2020年第4期228-230,共3页Trauma and Critical Care Medicine

摘　　要：目的探讨一期后前路联合手术治疗强直性脊柱炎(AS)患者颈椎骨折脱位伴脊髓损伤的疗效。方法回顾性分析自2013年4月至2018年3月新疆维吾尔自治区人民医院收治的因外伤受伤致颈椎骨折脱位伴脊髓损伤的8例AS患者临床资料。患者均采用一期后前路内固定手术治疗。采用Oswestry功能障碍指数(ODI)及Frankel量表评价术前、术后神经功能状态。以手术节段的骨融合率作为脊柱融合的评价指标。采用螺钉松动、折断、融合器下沉、钛棒折断等并发症发生率评价颈椎固定状态。结果本组患者随访时间12~36个月,平均随访时间(24.6±5.8)个月;手术时间(310.2±30.8)min;术中出血量(360.5±53.5)ml。7例患者术后无心脏骤停、心力衰竭、呼吸衰竭等严重并发症,神经功能障碍无恶化。1例患者因感染性休克发生弥散性血管内凝血后,于术后3 d死亡。7例患者术前ODI评分为(38.1±4.30)分,末次随访ODI评分为(13.8±1.82)分,差异有统计学意义(P<0.05)。术前,5例改良Frankel C2级患者无法站立,2例D2级和1例D1级患者只能用助行器行走;末次随访,2例患者由C2级恢复至D2级,5例患者均恢复至D3~E级,可独立行走,无任何辅助。术后12个月,脊柱骨融合率为100.0%(7/7),骨折愈合良好,未见植入的cage下沉,未见内固定松动。结论一期后前路联合手术治疗AS患者颈椎骨折脱位伴脊髓损伤的疗效较好,可稳定重建脊柱,脊柱骨融合率较高,神经功能恢复良好,并发症较少。Objective To investigate the clinical effect of one-stage posterior anterior approach combined with operation in the treatment of ankylosing spondylitis with cervical fracture dislocation and spinal cord injury.Methods A retrospective study was performed on 8 cases of AS patients with cervical fracture dislocation and spinal cord injury who were admitted from April 2013 to March 2018.All patients were treated with one-stage posterior anterior internal fixation.The Oswestry disability index(ODI)and Frankel scale were used to evaluate preoperative and postoperative neurological status.The rate of bone fusion in surgical segments was used as the evaluation index of spinal fusion.The incidence of screw loosening,fracture,fusion cage sinking,titanium rod breaking and other complications were used to evaluate the fixation status of cervical vertebra.Results The patients in this group were followed up for 12 to 36 months,with an average follow-up time of(24.6±5.8)months.The operation time was(310.2±30.8)minutes.Intraoperative blood loss(360.5±53.5)ml.Seven patients had no serious complications such as cardiac arrest,heart failure,respiratory failure and no worsening of neurological dysfunction.One patient died 3 days after disseminated intravascular coagulation due to septic shock.The preoperative ODI score of the 7 patients was(38.1±4.30)points,and the ODI score of the last follow-up was(13.8±1.82)points,with statistically significant differences(P<0.05).Preoperative 5 patients with modified Frankel Grade C2 could not stand,2 patients with Grade D2 and 1 patient with Grade D1 could only walk with a walker.In the last follow-up,2 patients recovered from Level C2 to Level D2,and all 5 patients recovered to level D3 to E,and could walk independently without any assistance.Twelve months after the operation,the spinal bone fusion rate was 100.0%(7/7),fracture healing was good,and no cage subsidence or internal fixation loosening was observed.Conclusion The one-stage posterior anterior combined operation for the treatme

关 键 词：强直性脊柱炎 颈椎骨折脱位 脊髓损伤 后前路联合入路 

分 类 号：R681[医药卫生—骨科学]