Glace B, Dubost J-J, Ristori J-M, Irthum B, Chazal J, Soubrier M
Service de rhumatologie, CHU Gabriel-Montpied, Clermont-Ferrand, France.
Rev Med Interne. 2011 May;32(5):283-6. doi: 10.1016/j.revmed.2010.10.356. Epub 2010 Dec 13.
Transverse fractures of the spine are rare. They occur in ankylosed spine and may lead to neurological complications. We report a series of 18 cases observed in 17 patients with ankylosing spondylitis (AS). The objective of this study were to describe the clinical, diagnostic and therapeutic features of our series and to compare our results with those of the literature.
We conducted a retrospective study from 1975 to 2008 in the neurosurgery and rheumatology departments of the university hospital (CHU) of Clermont-Ferrand.
Eighteen transverse spine fractures were documented in 17 patients (one female patient had two fractures of the lumbar vertebrae). The 13 male and four female patients included in this series had a mean age of 57.4 ± 17.2 years and AS for a mean time of 21.3 ± 12 years (5-40). All patients had spinal ankylosis with a "bamboo" spine appearance. The reasons for hospital admission were suspicion of AS flare (n=10) and suspected traumatic fracture (n=8). Trauma, in most cases minor, was noted in 15 patients. Fourteen patients presented with mechanical spinal pain and three had both mechanical and inflammatory pain. Three patients experienced severe pain on mobilization. Two patients had pyramidal syndrome. The mean time to diagnosis of the fracture was 6.8 ± 8.4 weeks (0-22). The fracture was located in cervical spine (n=2), dorsal spine (n=8) and lumbar spine (n=8). It was transdiscal and transcorporeal in nine cases each. Standard radiographs (n=18) identified the fracture in nine cases. The fracture was demonstrated in all CT-scan (n=13). Magnetic resonance imaging (MRI) (n=6) showed the fracture in five cases and epidural hematoma in one. Eleven patients had orthopedic treatment and six underwent surgery. Outcome was favorable in 16 patients. One paraplegic patient died of pulmonary embolism.
Transverse fractures of the spine are rare and diagnosis should be considered in a patient with AS and ankylosed spine who presented mechanical spine pain following even minor trauma. If standard radiographs are normal, further investigations should be performed using MRI, CT-scan, or both.
脊柱横断骨折较为罕见。其发生于脊柱强直患者，可能导致神经并发症。我们报告了在17例强直性脊柱炎（AS）患者中观察到的一系列18例病例。本研究的目的是描述我们这组病例的临床、诊断和治疗特征，并将我们的结果与文献报道的结果进行比较。
我们对1975年至2008年在克莱蒙费朗大学医院（CHU）神经外科和风湿病科进行了一项回顾性研究。
17例患者记录有18处脊柱横断骨折（1例女性患者有两处腰椎骨折）。该系列纳入的13例男性和4例女性患者平均年龄为57.4±17.2岁，患AS平均时间为21.3±12年（5 - 40年）。所有患者均有脊柱强直，呈“竹节样”脊柱外观。入院原因是怀疑AS病情加重（n = 10）和怀疑外伤性骨折（n = 8）。15例患者存在创伤，多数情况为轻伤。14例患者出现机械性脊柱疼痛，3例同时有机械性和炎性疼痛。3例患者活动时疼痛剧烈。2例患者出现锥体束征。骨折诊断的平均时间为6.8±8.4周（0 - 22周）。骨折位于颈椎（n = 2）、胸椎（n = 8）和腰椎（n = 8）。各有9例骨折为经椎间盘和经椎体骨折。18例标准X线片中有9例发现骨折。13例CT扫描均显示骨折。6例磁共振成像（MRI）中有5例显示骨折，1例显示硬膜外血肿。11例患者接受了骨科治疗，6例接受了手术。16例患者预后良好。1例截瘫患者死于肺栓塞。
脊柱横断骨折罕见，对于患有AS且脊柱强直的患者，即使有轻微创伤后出现机械性脊柱疼痛，也应考虑骨折诊断。如果标准X线片正常，应进一步行MRI、CT扫描或两者检查。
