Zhang WenSheng, Zheng MinQian
Department of Orthopedics, Yancheng First People's Hospital, Jiangsu Province, China.
J Spinal Disord Tech. 2014 Dec;27(8):423-30. doi: 10.1097/BSD.0b013e31828e9f0e.
There are no accurate guidelines on the operative treatment of ankylosing spondylitis (AS)-related thoracolumbar stress fractures. For this reason, we categorized such bone fractures into 2 types: vertebral body type and intervertebral space type, according to the damage mechanism, cross-section spot, and iconography, and devised a targeted surgical plan based on the characteristics of each fracture type.
To investigate the types and surgical treatment of thoracolumbar stress fractures in AS.
Thoracolumbar stress fractures are complications of AS. The patients with AS have a higher fracture risk that is approximately 3.5 times than the healthy. As the mechanism of injury, clinical manifestations, imaging characteristics, and principles of treatment of these fractures differ from those of general spinal fractures, the surgical approach is different from that of AS kyphosis orthopedic surgery. In this study, we summarize the clinical data of 11 AS patients with thoracolumbar fractures and discuss the clinical efficacy of the surgical approach based on the mechanism of injury and radiographic features.
We reviewed the data of 11 patients who underwent surgery for AS-related thoracolumbar stress fractures. Five patients with vertebral body-type fractures underwent vertebral wedge osteotomy through the pedicle and posterior internal fixation, whereas 6 patients with intervertebral space-type fractures underwent anterior spinal decompression with strut grafting and posterior internal fixation.
The follow-up period was 2-4 years. After surgery, all kyphosis deformities were corrected, low back pain was relieved immediately, and scores on the visual analog scale improved by >70%. At the final follow-up, kyphosis correction had no significant loss. In the radiographic images, neither nonunion signs of pseudarthrosis plane nor neurologic or infectious complications were observed.
Choosing an anterior or posterior surgical approach based on the type of AS-related thoracolumbar stress fracture can enhance the stability of the fracture, effectively restore the neurocanal volume and spinal column's axis of stress, reduce the complications of spinal cord damage, and produce the desired clinical curative effect.
目前对于强直性脊柱炎（AS）相关胸腰椎应力性骨折的手术治疗尚无准确的指导方针。因此，我们根据损伤机制、横截面部位及影像学表现，将此类骨折分为2种类型：椎体型和椎间隙型，并根据每种骨折类型的特点制定了针对性的手术方案。
探讨AS患者胸腰椎应力性骨折的类型及手术治疗方法。
胸腰椎应力性骨折是AS的并发症。AS患者发生骨折的风险较高，约为健康人的3.5倍。由于这些骨折的损伤机制、临床表现、影像学特征及治疗原则与一般脊柱骨折不同，其手术方式也与AS后凸矫形手术不同。在本研究中，我们总结了11例AS合并胸腰椎骨折患者的临床资料，并根据损伤机制及影像学特征探讨了手术方式的临床疗效。
我们回顾了11例行AS相关胸腰椎应力性骨折手术患者的数据。5例椎体型骨折患者采用经椎弓根椎体楔形截骨术及后路内固定，6例椎间隙型骨折患者采用前路撑开植骨减压及后路内固定。
随访时间为2至4年。术后，所有后凸畸形均得到矫正，腰痛立即缓解，视觉模拟评分改善>70%。末次随访时，后凸矫正无明显丢失。影像学检查未观察到假关节平面骨不连征象，也未出现神经或感染并发症。
根据AS相关胸腰椎应力性骨折的类型选择前路或后路手术方式，可增强骨折稳定性，有效恢复神经根管容积及脊柱应力轴，减少脊髓损伤并发症，产生理想的临床疗效。
