成人强直性脊柱炎合并胸腰椎骨折临床诊疗指南(2023版)  

Clinical guideline for diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture(version 2023)

作　　者：张嘉男 陈伯华[2] 初同伟 陈乙瑞 董健[5] 冯皓宇 范顺武[7] 冯世庆 高延征[9] 官众[10] 海涌[11] 贺利军 贺园 蒋电明 姜建元[14] 林斌 刘斌[16] 刘宝戈[17] 李淳德[18] 李放 李锋[20] 吕国华[21] 李利[22] 廖琦[23] 李危石[24] 刘晓光[24] 刘勇[25] 刘忠军[24] 鲁世保[26] 梅伟 邱勇[28] 戎利民[29] 申勇[30] 沈慧勇[31] 舒钧[32] 宋跃明[33] 孙宏慧 孙天胜 王岩[22] 王哲 王征[22] 西永明[2] 夏虹 闫景龙[36] 闫亮[1] 袁文 赵罡 赵杰[39] 仉建国[40] 周晓中[41] 朱悦[42] 张英泽[30] 郝定均[1] 贺宝荣[1] 中国医师协会骨科分会脊柱创伤专业学组 Zhang Jianan;Chen Bohua;Chu Tongwei;Chen Yirui;Dong Jian;Feng Haoyu;Fan Shunwu;Feng Shiqing;Gao Yanzheng;Guan Zhong;Hai Yong;He Lijun;He Yuan;Jiang Dianming;Jiang Jianyuan;Lin Bin;Liu Bin;Liu Baoge;Li dechun;Li Fang;Li Feng;Lyu Guohua;Li li;Liao Qi;Li Weishi;Liu Xiaoguang;Liu Yong;Liu Zhongjun;Lu Shibao;Mei Wei;Qiu Yong;Rong Limin;Shen Yong;Shen Huiyong;Shu Jun;Song Yueming;Sun Honghui;Sun Tiansheng;Wang Yan;Wang Zhe;Wang Zheng;Xi Yongming;Xia Hong;Yan Jinglong;Yan Liang;Yuan Wen;Zhao Gang;Zhao Jie;Zhang Jianguo;Zhou Xiaozhong;Zhu Yue;Zhang Yingze;Hao Dingjun;He Baorong;Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association(Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China;Affiliated Hospital of Qingdao University,Qingdao 266003,China;Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Chongqing University Three Gorges Hospital,Chongqing 404000,China;Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China;Shanxi Bethune Hospital,Taiyuan 030032,China;Sir Run Run Shaw Hospital,Zhejiang University Medical College,Hangzhou 310016,China;Second Hospital of Shandong University,Jinan 250033,China;Henan Provincial People's Hospital,Zhengzhou 450003,China;Affiliated Hospital of Qinghai University,Xining 810001,China;Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;Xi'an No.5 Hospital,Xi'an 710082,China;Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;15909th Hospital of Joint Logistics Support Force,Zhangzhou 363099,China;Inner Mongolia Medical University,Huhhot 101110,China;Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Peking University First Hospital,Beijing 100034,China;Seventh Medical Center of PLA General Hospital,Beijing 100026,China;Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China;Second Xiangya Hospital of Central South

机构地区：[1]西安交通大学附属红会医院,西安710054 [2]青岛大学附属医院,青岛266003 [3]陆军军医大学第二附属医院,重庆400037 [4]重庆大学附属三峡医院,重庆404000 [5]复旦大学附属中山医院,上海200032 [6]山西白求恩医院,太原030032 [7]浙江大学医学院邵逸夫医院,杭州310016 [8]山东大学第二医院,济南250033 [9]河南省人民医院,郑州450003 [10]青海大学附属医院,西宁810001 [11]首都医科大学附属北京朝阳医院,北京100020 [12]西安市第五医院,西安710082 [13]重庆医科大学附属第三医院,重庆401120 [14]复旦大学附属华山医院,上海200040 [15]联勤保障部队第九〇九医院,漳州363099 [16]内蒙古医科大学,呼和浩特101110 [17]首都医科大学附属北京天坛医院,北京100070 [18]北京大学第一医院,北京100034 [19]中国人民解放军总医院第七医学中心,北京100026 [20]华中科技大学同济医学院附属同济医院,武汉430030 [21]中南大学湘雅二医院,长沙410012 [22]中国人民解放军总医院,北京100853 [23]南昌大学附属第三医院,南昌330008 [24]北京大学第三医院,北京100191 [25]西藏自治区人民医院,拉萨850010 [26]首都医科大学附属北京宣武医院,北京100053 [27]郑州人民医院,郑州450053 [28]南京大学医学院附属鼓楼医院,南京210008 [29]中山大学附属第三医院,广州510630 [30]河北医科大学第三医院,石家庄050051 [31]中山大学附属第八医院,深圳518033 [32]昆明医科大学第二附属医院,昆明650106 [33]四川大学华西医院,成都610041 [34]空军军医大学西京医院,西安710032 [35]解放军南部战区总医院,广州510010 [36]哈尔滨医科大学附属第二医院,哈尔滨150001 [37]海军军医大学第二附属医院,上海200003 [38]周口协和骨科医院,周口466000 [39]上海交通大学医学院附属第九人民医院,上海200011 [40]北京协和医院,北京100032 [41]苏州大学附属第二医院,苏州215004 [42]中国医科大学附属�

出　　处：《中华创伤杂志》2023年第3期204-213,共10页Chinese Journal of Trauma

摘　　要：强直性脊柱炎(AS)合并胸腰椎骨折具有骨折不稳定、神经损伤发生率高、致残和致死率高等特点。AS合并胸腰椎骨折多由低能量损伤造成,且脊柱强直及骨质疏松对影像学检查准确性的干扰较大,故易漏诊。同时,其治疗方案的选择也存在争议性,缺少相关规范。非手术治疗易导致骨不连、假关节形成及迟发性神经损伤,而手术治疗也存在内固定失效导致手术失败的风险。对于AS合并胸腰椎骨折,目前尚无基于循证医学证据的诊疗指南。因此,中国医师协会骨科分会脊柱创伤专业学组组织专家遵循循证医学原则,本着科学性和实用性,对相关文献进行系统回顾分析,制订《成人强直性脊柱炎合并胸腰椎骨折临床诊疗指南(2023版)》,从诊断、影像学评估、分型及治疗等方面提出10条推荐建议,以规范AS合并胸腰椎骨折的临床诊疗。Ankylosing spondylitis(AS)combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture,high incidence of nerve injury,high mortality and high disability rate.The diagnosis may be missed because it is mostly caused by low-energy injury,when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination.At the same time,the treatment choices are controversial,with no relevant specifications.Non-operative treatments can easily lead to bone nonunion,pseudoarthrosis and delayed nerve injury,while surgeries may be failed due to internal fixation failure.At present,there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture.In this context,the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture(version 2023)by following the principles of evidence-based medicine and systematically review related literatures.Ten recommendations on the diagnosis,imaging evaluation,classification and treatment of AS combined with thoracic and lumbar fracture were put forward,aiming to standardize the clinical diagnosis and treatment of such disorder.

关 键 词：脊柱炎 强直性 胸椎 腰椎 脊柱骨折 指南 

分 类 号：R593.23[医药卫生—内科学] R683.2[医药卫生—临床医学]