Kaneko Takahisa, Koyanagi Izumi, Murakami Tomohiro, Houkin Kiyohiro
Department of Neurosurgery,Sapporo Medical University School of Medicine.
No Shinkei Geka. 2010 Sep;38(9):839-43.
We report a case of a 61-year-old man with ankylosing spondylitis who showed cervical spine fracture. The patient had fallen down on the floor and presented with severe neck pain. He was treated conservatively with a hard neck collar in an emergency hospital because of C7 body fracture without dislocation. However, the follow-up radiographs demonstrated a progressive C6-7 anterior dislocation. He was referred to our hospital 6 weeks after the trauma. The 3D-CT reconstruction imaging revealed that the fracture extended from the C7 vertebral body to the C6 lamina via the bilateral C6/7 facet joints. The patient underwent C2-Th3 posterior fixation using pedicle and lateral mass screw techniques. The postoperative course was uneventful. He was discharged without any complication at 1 month postoperatively. The radiograph 3 months after surgery showed good bone fusion. Spine fracture with ankylosing spondylitis usually shows significant instability because of the long lever-arm of the fused vertebrae at the fracture level. Solid spinal fusions such as long posterior fusion or anterior-posterior simultaneous fusion are needed in such cases.
我们报告一例61岁患有强直性脊柱炎的男性发生颈椎骨折的病例。患者摔倒在地，出现严重颈部疼痛。因其C7椎体骨折无脱位，在一家急诊医院接受了硬颈托保守治疗。然而，后续X线片显示C6 - 7椎体逐渐向前脱位。外伤6周后他被转诊至我院。三维CT重建影像显示骨折从C7椎体经双侧C6/7小关节延伸至C6椎板。患者采用椎弓根和侧块螺钉技术进行了C2 - Th3后路固定。术后过程顺利。术后1个月他无任何并发症出院。术后3个月的X线片显示骨融合良好。强直性脊柱炎合并脊柱骨折通常因骨折水平融合椎体的长臂而表现出明显的不稳定性。在此类病例中需要进行如长节段后路融合或前后路同时融合等坚固的脊柱融合术。
