Lu Meng-Ling, Tsai Tsung-Ting, Lai Po-Liang, Fu Tsai-Sheng, Niu Chi-Chien, Chen Lih-Huei, Chen Wen-Jer
Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Eur J Orthop Surg Traumatol. 2014 Jul;24 Suppl 1:S117-23. doi: 10.1007/s00590-013-1375-y. Epub 2013 Dec 4.
Spinal fractures are commonly encountered in ankylosing spondylitis (AS) patients. This study compares the outcome of early surgical treatment with initial conservative treatment for thoracolumbar fractures in patients with AS. From 1996 to 2008, 28 patients with AS were treated either operatively or conservatively for thoracolumbar fractures; however, only 25 patients met the inclusion criteria with a minimum follow-up of 2 years. For surgically treated patients, posterior spinal instrumentation was performed using a transpedicle screw system. Nonsurgically treated patients wore a fracture brace. The demographic data, diagnosis, mechanism of injury, and neurological status were recorded, and fracture healing was assessed radiographically. The mean age was 54.2 ± 13.8 years (range 30-80 years). Six patients (Group A) received surgical intervention within 1 month. All of these fractures healed, and two of five patients showed neurologic improvement after surgery. Eight patients (Group B) had fractures that were missed. The delay in diagnosis resulted in pseudoarthrosis in all cases, and progressive neurologic deficits were identified in four cases. Eleven patients (Group C) received conservative treatment with bracing. Fracture union was achieved in three cases, and pseudoarthrosis occurred in eight cases. Operative treatment can achieve solid fusion and improve the neurological status, while conservative treatment may result in pseudoarthrosis and progressive neurologic deficit. The results suggest that AS patients with unstable spinal fractures should receive early surgical management to prevent further sequelae.
脊柱骨折在强直性脊柱炎（AS）患者中较为常见。本研究比较了AS患者胸腰椎骨折早期手术治疗与初始保守治疗的效果。1996年至2008年，28例AS患者因胸腰椎骨折接受了手术或保守治疗；然而，只有25例患者符合纳入标准，且随访时间至少为2年。对于接受手术治疗的患者，采用椎弓根螺钉系统进行后路脊柱内固定。未接受手术治疗的患者佩戴骨折支具。记录患者的人口统计学数据、诊断、损伤机制和神经状态，并通过影像学评估骨折愈合情况。平均年龄为54.2±13.8岁（范围30 - 80岁）。6例患者（A组）在1个月内接受了手术干预。所有这些骨折均愈合，5例患者中有2例术后神经功能改善。8例患者（B组）骨折被漏诊。诊断延迟导致所有病例均出现假关节形成，4例出现进行性神经功能缺损。11例患者（C组）接受支具保守治疗。3例实现骨折愈合，8例出现假关节形成。手术治疗可实现牢固融合并改善神经状态，而保守治疗可能导致假关节形成和进行性神经功能缺损。结果表明，AS合并不稳定脊柱骨折的患者应尽早接受手术治疗以预防进一步的后遗症。
