强直性脊柱炎合并弥漫性特发性骨肥厚腰椎术后翻修一例  

Ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis in a patient who required reoperation of lumber: a case report

作　　者：魏超[1] 李涛[1] WEI Chao;LI Tao(Department of Spine Surgery,the Central Hospital of Zibo,Shandong Province,Zibo 255036,China)

机构地区：[1]山东省淄博市中心医院脊柱外科,255036

出　　处：《临床外科杂志》2021年第2期170-173,共4页Journal of Clinical Surgery

摘　　要：目的强直性脊柱炎(AS)和弥漫性特发性骨肥厚(DISH病)均为脊柱强直性疾病,二者同时发生临床极为少见,同时合并腰椎管狭窄目前国内尚无报道,我们遇到1例初次手术失败的此诊断的病人,通过分析此例病例的特点,回顾文献,提高临床医生对此类少见的疾病认识和诊疗水平。方法收集此例病人初次手术前后及随访时的临床及影像资料,结合相关文献,分析初次手术失败原因,指导翻修手术方案的制定。翻修手术按照术前计划完成,术后进行短时间随访,观察病人临床疗效及有无内置物相关并发症,从而对此类疾病诊疗提供初步的指导意见。结果此例病人初次手术诊断错误,手术方案制定不当,故手术失败,内置物松动。内置物之所以松动,与手术阶段应力集中、固定阶段短、未行椎间融合等诸多因素相关,翻修手术行长阶段固定,椎间融合后,病人临床疗效满意,短时间随访,无内置物相关并发症。结论 AS和DISH二者可以并存;DISH病可以增加腰椎管狭窄手术率;单纯减压及短阶段固定翻修率高,建议行长阶段固定融合。Objective Ankylosing spondylitis(AS)and diffuse idiopathic skeletal hyperostosis(DISH) are both spinal ankylosing conditions.Simultaneous occurrence of both conditions is rare, and the present of lumbar spinal stenosis(LSS) had not been reported at the same time.We encountered a patient with this diagnosis whose initial operation had failed through analyzing the characteristics of the this example patient, review of the literature, So as to improve the understanding of clinicians to such rare diseases, improve the level of diagnosis and treatment,and improve the level of diagnosis and treatment.Methods The clinical and imaging data of this patient before and after the initial operation and during the follow-up were collected.Combined with relevant literature, the reasons for the failure of the initial operation were analyzed, to guide re-operation plan;re-operation was completed according to the preoperative plan, followed up for a short time after surgery to observe the clinical efficacy of the patients and whether there were implants-related complications, so as to provide preliminary guidance for the diagnosis and treatment of such diseases.Results In this case, the diagnosis was wrong during the first operation and the operation plan was not made properly, so the first operation failed and the internal plants loose.the failure of the was internal plants related to the stress concentration in the surgical stage, the short fixation stage, the absence of intervertebral fusion and many other factors.The long stage fixation in revision surgery, after intervertebral fusion, had satisfactory clinical efficacy, and no implant-related complications in the following up.Conclusion AS and DISH should not be seen as mutually exclusive.DISH is associated with lumbar spinal stenosis requiring surgery.Decompression and short-segment fixation in LSS patients with DISH was characterized by high rate of reoperation, long-segment fixed fusion is recommended.

关 键 词：强直性脊柱炎 弥漫性特发性骨肥厚 腰椎管狭窄 内置物 并发症 

分 类 号：R687.3[医药卫生—骨科学]