Paley D, Schwartz M, Cooper P, Harris W R, Levine A M
Department of Neurosurgery, Sunnybrook Hospital, Toronto, Canada.
Clin Orthop Relat Res. 1991 Jun(267):22-32.
Fractures of the spine in diffuse idiopathic skeletal hyperostosis (DISH) have rarely been reported. Only four cases could be found in the world literature. Eight new cases with nine fractures are reported in this study. The critical features are the frequent delays in diagnosis (three of eight patients) and the high rate of immediate and delayed neurologic deficit (seven of eight patients). Two fracture patterns occurred in this group. The first type occurred through the midportion of an ankylosed segment of the spine and involved the vertebral body (five fractures). The second type occurred at the top or bottom of a fused segment (four fractures). The latter were disk disruptions or odontoid fractures. This is a marked difference from spinal fractures in ankylosing spondylitis, in which the majority are transdiskal fractures. The difference can be explained on the basis of the different pathology of these two disease processes. Careful evaluation of patients with DISH who sustain trauma is critical. Treatment of this rare injury should be early stabilization of the spine to avoid complications of nonunion, deformity, neurologic injury, and death.
弥漫性特发性骨肥厚（DISH）中脊柱骨折鲜有报道。世界文献中仅发现4例。本研究报告了8例新病例，共9处骨折。关键特征是诊断频繁延迟（8例患者中有3例）以及即刻和延迟神经功能缺损发生率高（8例患者中有7例）。该组出现了两种骨折类型。第一种类型发生在脊柱强直节段的中部，累及椎体（5处骨折）。第二种类型发生在融合节段的顶部或底部（4处骨折）。后者为椎间盘破裂或齿状突骨折。这与强直性脊柱炎中的脊柱骨折有显著差异，强直性脊柱炎中的大多数骨折为经椎间盘骨折。这种差异可基于这两种疾病过程的不同病理来解释。对遭受创伤的DISH患者进行仔细评估至关重要。对这种罕见损伤的治疗应尽早进行脊柱稳定，以避免骨不连、畸形、神经损伤和死亡等并发症。
