Reinhold Maximilian, Knop Christian, Kneitz Christian, Disch Alexander
Klinikum Südstadt Rostock, Rostock, Germany.
Klinikum Stuttgart, Stuttgart, Germany.
Global Spine J. 2018 Sep;8(2 Suppl):56S-68S. doi: 10.1177/2192568217736268. Epub 2018 Sep 7.
Review of literature and case series.
Update and review of current treatment concepts for spine fractures in patients with ankylosing spinal disorders.
Case presentation and description of a diagnostic and therapeutic algorithm for unstable spinal injuries with an underlying ankylosing spinal disorder (ASD) of the cervical and thoracolumbar spine.
Nondisplaced fractures can be missed easily using conventional X-rays. Thus, computed tomography (CT) scans are recommended for all trauma patients with ASD. In doubt or presence of any neurologic involvement additional magnetic resonance imaging (MRI) scans should be obtained. Spine precautions should be maintained all times and until definitive treatment (<24 h). Nonoperative fracture treatment is not recommended given the mechanical instability of the most commonly seen fracture patterns (AOSpine B- and C-type, M2) in patients with ASD and inherent high risk of secondary neurologic deterioration. For patients with ankylosing spondylitis (AS) or diffuse idiopathic hyperostosis (DISH) sustaining cervical spine fractures, a combined anterior-posterior instrumentation for fracture fixation is recommended. Closed reduction and patient positioning can be challenging in presence of preexisting kyphotic deformities. In the thoracolumbar (TL) spine, a posterior instrumentation extending 2 to 3 levels above and below the fracture level is recommended to maintain adequate reduction and stability until fracture healing. Minimally invasive percutaneous pedicle screws and cement augmentation can help to minimize the surgical trauma and strengthen the construct stability in patients with diminished minor bone quality (osteopenia, osteoporosis).
Current concepts, treatment options, and recommendations of the German Orthopedic Trauma Society-Spine Section for spinal fractures in the ankylosed spine have been outlined.
文献综述与病例系列研究。
更新并综述强直性脊柱炎患者脊柱骨折的当前治疗理念。
病例展示以及对伴有颈椎和胸腰椎潜在强直性脊柱炎（ASD）的不稳定脊柱损伤的诊断与治疗算法的描述。
使用传统X线片容易漏诊无移位骨折。因此，建议对所有患有ASD的创伤患者进行计算机断层扫描（CT）。如有疑问或存在任何神经受累情况，应额外进行磁共振成像（MRI）扫描。应始终采取脊柱防护措施，直至确定治疗（<24小时）。鉴于ASD患者中最常见骨折类型（AOSpine B型和C型，M2）的机械不稳定性以及继发神经功能恶化的固有高风险，不建议采用非手术骨折治疗。对于患有强直性脊柱炎（AS）或弥漫性特发性骨肥厚（DISH）且发生颈椎骨折的患者，建议采用前后联合内固定进行骨折固定。在存在既往驼背畸形的情况下，闭合复位和患者体位摆放可能具有挑战性。在胸腰椎（TL）脊柱，建议在骨折水平上下各延伸2至3个节段进行后路内固定，以维持充分复位和稳定性直至骨折愈合。微创经皮椎弓根螺钉和骨水泥强化有助于将手术创伤降至最低，并增强骨质量较差（骨质减少、骨质疏松）患者的内固定稳定性。
概述了德国骨科创伤协会脊柱分会关于强直性脊柱炎脊柱骨折的当前理念、治疗选择和建议。
