Robinson Yohan, Sandén Bengt, Olerud Claes
Department of Orthopaedics, Uppsala University Hospital, Institute for Surgical Sciences, Uppsala, 75185, Sweden.
Patient Saf Surg. 2013 Jan 7;7(1):2. doi: 10.1186/1754-9493-7-2.
Ankylosing spondylitis (AS) is a rheumatoid disease leading to progressive ossification of the spinal column. Patients suffering from AS are highly susceptible to unstable vertebral fractures and often require surgical stabilisation due to long lever arms. Medical treatment of these patients improved during the last decades, but until now it is unknown whether the annual number of spinal fractures changed during the last years. Since the annual count of fracture is an effective measure for efficacy of injury prevention and patient safety in AS patients, the current recommendations of activity have to be revised accordingly.
Data for all patients with AS treated as inpatients between 01/01/1987 and 31/12/2008 were extracted from the Swedish National Hospital Discharge Registry (SNHDR). The data in the registry are collected prospectively, recording all inpatient admissions throughout Sweden. The SNHDR uses the codes for diagnoses at discharge according to the Swedish versions of the International Classification of Diseases (ICD-9 and ICD-10).
During the years from 1987 to 2008 17,764 patients with AS were treated as inpatients; of these 724 patients were treated due to spinal fractures. The annual number of cervical, thoracic and lumbar fractures in the registry increased until 2008 (r = 0.94).
Despite the improved treatment of AS the annual number of vertebral fractures requiring inpatient care increased during the last two decades. Possible explanations are population growth, greater awareness of fractures, improved diagnostics, improved emergency care reducing fatalities, and a higher activity level of patients receiving modern medical therapy. Obviously the improvement of medical treatment did not reduce the susceptibility of these patients to unstable fractures. Thus the restrictive injury prevention recommendations for patients with AS cannot be defused, but must be critically revised to improve patient safety.
强直性脊柱炎（AS）是一种导致脊柱进行性骨化的类风湿性疾病。AS患者极易发生不稳定的椎体骨折，且由于杠杆臂较长，常需手术固定。在过去几十年中，这些患者的医疗治疗有所改善，但到目前为止，尚不清楚过去几年脊柱骨折的年发生率是否发生了变化。由于骨折年计数是衡量AS患者预防损伤效果和患者安全性的有效指标，因此当前的活动建议必须相应修订。
从瑞典国家医院出院登记处（SNHDR）提取1987年1月1日至2008年12月31日期间所有住院治疗的AS患者的数据。登记处的数据是前瞻性收集的，记录了瑞典各地所有住院患者的情况。SNHDR根据国际疾病分类（ICD-9和ICD-10）的瑞典版本使用出院时的诊断代码。
1987年至2008年期间，17764例AS患者接受了住院治疗；其中724例因脊柱骨折接受治疗。登记处中颈椎、胸椎和腰椎骨折的年发生率在2008年之前呈上升趋势（r = 0.94）。
尽管AS的治疗有所改善，但在过去二十年中，需要住院治疗的椎体骨折年发生率仍有所增加。可能的解释包括人口增长、对骨折的认识提高、诊断改善、急救改善减少了死亡率以及接受现代医学治疗的患者活动水平提高。显然，医疗治疗的改善并未降低这些患者发生不稳定骨折的易感性。因此，针对AS患者的限制性预防损伤建议不能放松，而必须进行严格修订以提高患者安全性。
