Yan Liang, Luo Zhenguo, He Baorong, Liu Jijun, Hao Dingjun
Department of Spinal Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, 555 Friendship East Road, Xi'an, 710054, Shaanxi, China.
Department of Anesthesiology, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, 555 Friendship East Road, Xi'an, 710054, Shaanxi, China.
BMC Musculoskelet Disord. 2017 Feb 14;18(1):81. doi: 10.1186/s12891-017-1396-5.
The most common site of fractures in patients with ankylosing spondylitis (AS) is the cervical spine, especially the lower cervical spine and cervicothoracic junction. The optimal treatment for cervical spine fractures secondary to AS is controversial. This study aimed to explore the effects of posterior pedicle screw fixation alone on fractures of the lower cervical spine in patients with AS.
From January 2006 to January 2013, a total of 35 patients with AS and a lower cervical spine fracture were treated using only posterior cervical/thoracic pedicle screw fixation. In this retrospective study, we reviewed the patients' charts to assess their case histories, operations, neurological outcomes, and complications. We also evaluated their postoperative radiographs to determine the time of bone fusion.
Altogether, 32 (91.4%) of the 35 fractures resulted from an acute injury and 3 (8.6%) from a chronic injury. In 25 cases, the fracture resulted from a low-energy spinal injury and in 8 cases from a high-energy injury. Posterior pedicle screw fixation was successful in all patients, with radiographic fusion confirmed by computed tomography. The average time of bone fusion was 3.6 months (range 3 - 6 months). The surgery improved the American Spinal Injury Association grade in 15 (42.9%) patients. No intraoperative complications occurred. None of the corrections resulted in neurological decompensation. The average postoperative correction was 18°.
Pedicle screw fixation and autologous bone grafting through a single posterior approach to lower cervical spine fractures in AS patients could stabilize the spine, correct kyphosis, and relieve pressure. It is thus reasonable to recommend this surgical strategy for AS-associated fractures of the lower cervical spine.
Not applicable.
强直性脊柱炎（AS）患者骨折最常见的部位是颈椎，尤其是下颈椎和颈胸交界处。AS继发颈椎骨折的最佳治疗方法存在争议。本研究旨在探讨单纯后路椎弓根螺钉固定对AS患者下颈椎骨折的影响。
2006年1月至2013年1月，共有35例AS合并下颈椎骨折的患者仅接受了颈胸后路椎弓根螺钉固定治疗。在这项回顾性研究中，我们查阅了患者的病历，以评估他们的病史、手术情况、神经功能结果和并发症。我们还评估了他们术后的X线片，以确定骨融合时间。
35例骨折中，共32例（91.4%）由急性损伤引起，3例（8.6%）由慢性损伤引起。25例骨折由低能量脊柱损伤导致，8例由高能量损伤导致。所有患者后路椎弓根螺钉固定均成功，计算机断层扫描证实有影像学融合。平均骨融合时间为3.6个月（范围3 - 6个月）。手术使15例（42.9%）患者的美国脊髓损伤协会分级得到改善。术中无并发症发生。所有矫正均未导致神经功能失代偿。术后平均矫正角度为18°。
通过单一后路对AS患者下颈椎骨折进行椎弓根螺钉固定和自体骨移植可稳定脊柱、矫正后凸畸形并减轻压迫。因此，推荐将这种手术策略用于AS相关的下颈椎骨折是合理的。
不适用。
