Rustagi Tarush, Drazin Doniel, Oner Cumhur, York Jonathan, Schroeder Gregory D, Vaccaro Alexander R, Oskouian Rod J, Chapman Jens R
*Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA; †Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands; ‡Neurosurgical Associates, University of Tennessee Medical Center, Knoxville, TN, USA; and §Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
J Orthop Trauma. 2017 Sep;31 Suppl 4:S57-S74. doi: 10.1097/BOT.0000000000000953.
Spinal ankylosing disorders encompass ankylosing spondylitis (AS), disseminated hyperostosis of the spine, and end-stage spondylosis. All these result in a stiffened and frequently deformed spinal column. This makes the spinal column highly susceptible to severe injuries that are commonly associated with unfavorable outcomes. Improved understanding of the underlying disease processes and clinical comorbidities may alter the poor injury related morbidity and mortality outcomes.
A systematic review of the MEDLINE and PubMed databases was performed using the following key words to identify articles published between 2001 and 2016: "ankylosing spondylitis," "epidemiology," "DISH," "treatment," "outcome," and/or "fracture." Articles were read for data on methodology (retrospective vs. prospective), type of treatment, number of patients, mean patient age, and mean follow-up.
Twenty-one identified articles were analyzed. Average age was 63.4 years. Most patients were men. Ground level fall or low energy trauma caused most injuries. Diagnosis was delayed in 15%-41% cases. Hyperextension fracture patterns were most common. Cervical spine fractures were more common than thoracolumbar fractures, with the highest prevalence between C5 and C7. Neurologic deficits were encountered in 21%-100% of patients. Operative fixation and fusion were performed in 40%-100% of patients. Mortality was reported between 0% and 32% at 1 year postinjury. Complications were encountered in 84% of patients, mostly in the form of pneumonia, respiratory failure, and pseudoarthrosis. Neurologic deterioration has been reported in 16% of patients. Fusion was successful in 87%-100% of patients. Neurologic deficits improved in function in 6%-66% at the final follow-up.
Because of the stiffening of the spinal column, patients with spinal ankylosing disorders are preferably evaluated for spinal fractures and ligamentous injuries after even trivial trauma. Spinal injuries in patients with AS are difficult to diagnose on plain radiographs; computed tomography and magnetic resonance imaging are recommended instead. The entire spine should be scanned for multilevel involvement. Although osteoporosis makes fixation of spine implants a significant concern, the literature has reported that most patients with AS treated surgically had good outcomes. Numerous studies have reported risks associated with conservative management.
脊柱强直性疾病包括强直性脊柱炎（AS）、弥漫性脊柱骨肥厚和终末期脊柱病。所有这些都会导致脊柱僵硬并常常变形。这使得脊柱极易遭受严重损伤，而这些损伤通常会带来不良后果。对潜在疾病过程和临床合并症的深入了解可能会改变与损伤相关的不良发病率和死亡率结果。
使用以下关键词对MEDLINE和PubMed数据库进行系统综述，以识别2001年至2016年发表的文章：“强直性脊柱炎”、“流行病学”、“弥漫性特发性骨肥厚（DISH）”、“治疗”、“结果”和/或“骨折”。阅读文章以获取有关方法学（回顾性与前瞻性）、治疗类型、患者数量、平均患者年龄和平均随访时间的数据。
对21篇已识别的文章进行了分析。平均年龄为63.4岁。大多数患者为男性。大多数损伤由平地跌倒或低能量创伤引起。15% - 41%的病例诊断延迟。过伸性骨折模式最为常见。颈椎骨折比胸腰椎骨折更常见，C5至C7之间的患病率最高。21% - 100%的患者出现神经功能缺损。40% - 100%的患者进行了手术固定和融合。受伤后1年的死亡率报告为0%至32%。84%的患者出现并发症，主要形式为肺炎、呼吸衰竭和假关节。16%的患者报告有神经功能恶化。87% - 100%的患者融合成功。在最终随访时，6% - 66%的患者神经功能缺损在功能上有所改善。
由于脊柱僵硬，脊柱强直性疾病患者即使遭受轻微创伤后也最好接受脊柱骨折和韧带损伤评估。AS患者的脊柱损伤在X线平片上难以诊断；建议改用计算机断层扫描和磁共振成像。应扫描整个脊柱以检查是否存在多节段受累。尽管骨质疏松使脊柱植入物的固定成为一个重大问题，但文献报道大多数接受手术治疗的AS患者预后良好。许多研究报告了保守治疗相关的风险。
