摘要
[目的]探讨强直性脊柱炎合并胸腰椎骨折的手术治疗方法：[方法]对8例强直性脊柱炎并胸腰椎骨折的病人进行回顾性分析。其中2例患者双下肢麻木、肌力Ⅲ级，按Frankel分级，2例均为C级；余无神经损伤症状。8例患者均采用全麻下后入路骨折椎体切开复位椎弓根钉系统内同定，术中根据横突和上下关节突残留关节间隙仔细确认进钉点，上下各固定2个椎体、打入4枚椎弓根钉，钉尾安装连接系统，使骨折椎体撑开后拧紧连接系统各螺帽。对于2例有脊髓损伤症状的患者行椎管减压。[结果]8例患者术中均未发生血管、神经损伤等严重并发症。术后早期恢复良好，全部患者均获得随访，随访时间8～30个月。2例有脊髓损伤患者神经功能完全恢复，Frankel分级由C级进步为E级。影像学检查显示骨折愈合良好，内固定物无松动和断裂，动力性摄片未见骨折固定节段不稳征象。[结论]强直性脊柱炎合并胸腰椎骨折大部分是整个椎体的骨折、脱位，所以极不稳定，经后路上下各固定2个椎体、打入4枚椎弓根钉的固定方法取得了较好疗效。它可以使骨折处获得坚强内固定，从而为骨折愈合提供了一个稳定环境，使骨折尽早愈合。
[ Objective] To investigate surgical protocol for treatment of thoracolumbar fracture with aukylosing spondylitis. [Method] A retrospective study was performed in 8 thoracolumbar-fracture patients with ankylosing spondylitis. Of them, 6 patients were neurological intact and 2 had neurological defect（ Frankel grades the C level）, Under general anesthesia, all of the 8 patients underwent open reduction and internal fixation with pediele screws at two segments in both ends of the fracture. Larninectomy for decompression of the nerve tissue was performed in the 2 patients with neurological defect simuhaneously. [ Result ] All of the 8 patients were followed up for 8 to 30 months. Solid bone healing was achieved in all of the patients, Two patients with enrological compromise had improved by two Frankel grades （complete recovery）. [ Conclusion ] Thoraeolumbar fracture in ankylosing spondylitis traverse both bone and ligaments, producing an extremely unstable situation similar to a shearipg type of fracture. Reduction of the displacement and stabilization is best achieved with a pedicle screw system at two segments in both ends of the fracture.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2006年第22期1713-1715,共3页
Orthopedic Journal of China
关键词
强直性脊柱炎
胸腰椎骨折
手术治疗
椎弓螺钉
ankylosing spondylitis
thoracolumber fracture
surgerical treatment
pedicle screw swtem
