Okada Eijiro, Yoshii Toshitaka, Yamada Tsuyoshi, Watanabe Kei, Katsumi Keiichi, Hiyama Akihiko, Watanabe Masahiko, Nakagawa Yukihiro, Okada Motohiro, Endo Teruaki, Shiraishi Yasuyuki, Takeuchi Kazuhiro, Matsunaga Shunji, Maruo Keishi, Sakai Kenichiro, Kobayashi Sho, Ohba Tetsuro, Wada Kanichiro, Ohya Junichi, Mori Kanji, Tsushima Mikito, Nishimura Hirosuke, Tsuji Takashi, Okawa Atsushi, Matsumoto Morio, Watanabe Kota
Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan; Dept. of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan.
Dept. of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan.
J Orthop Sci. 2019 Jul;24(4):601-606. doi: 10.1016/j.jos.2018.12.017. Epub 2019 Jan 22.
Diffuse idiopathic skeletal hyperostosis (DISH) increases the spine's susceptibility to unstable fractures that can cause neurological deterioration. However, the detail of injury is still unclear. A nationwide multicenter retrospective study was conducted to assess the clinical characteristics and radiographic features of spinal fractures in patients with DISH.
Patients were eligible for this study if they 1) had DISH, defined as flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, and 2) had an injury in the ankylosing spine. This study included 285 patients with DISH (221 males, 64 females; mean age 75.2 ± 9.5 years).
The major cause of injury was falling from a standing or sitting position; this affected 146 patients (51.2%). Diagnosis of the fracture was delayed in 115 patients (40.4%). Later neurological deterioration by one or more Frankel grade was seen in 87 patients (30.5%). The following factors were significantly associated with neurological deficits: delayed diagnosis (p = 0.033), injury of the posterior column (p = 0.021), and the presence of ossification of the posterior longitudinal ligament (OPLL) (p < 0.001). The majority of patients (n = 241, 84.6%) were treated surgically, most commonly by conventional open posterior fixation (n = 199, 69.8%). Neurological improvement was seen in 20.0% of the conservatively treated patients, and in 47.0% of the patients treated surgically.
Minor trauma could cause spinal fractures in DISH patients. Delayed diagnosis, injury of the posterior column, and the presence of OPLL were significantly associated with neurological deterioration. Patients with neurological deficits or unstable fractures should be treated by fixation surgery.
弥漫性特发性骨肥厚（DISH）增加了脊柱发生不稳定骨折的易感性，而这种骨折可导致神经功能恶化。然而，损伤细节仍不清楚。开展了一项全国多中心回顾性研究，以评估DISH患者脊柱骨折的临床特征和影像学特征。
符合以下条件的患者纳入本研究：1）患有DISH，定义为沿至少四个连续椎体的前外侧缘出现流水样骨化；2）强直性脊柱炎部位有损伤。本研究纳入了285例DISH患者（男性221例，女性64例；平均年龄75.2±9.5岁）。
损伤的主要原因是从站立或坐位跌倒；146例患者（51.2%）受此影响。115例患者（40.4%）骨折诊断延迟。87例患者（30.5%）出现一个或多个Frankel分级的后期神经功能恶化。以下因素与神经功能缺损显著相关：诊断延迟（p = 0.033）、后柱损伤（p = 0.021）和后纵韧带骨化（OPLL）的存在（p < 0.001）。大多数患者（n = 241，84.6%）接受了手术治疗，最常见的是传统开放性后路固定术（n = 199，69.8%）。保守治疗的患者中有20.0%神经功能改善，手术治疗的患者中有47.0%神经功能改善。
轻微创伤可导致DISH患者发生脊柱骨折。诊断延迟、后柱损伤和OPLL的存在与神经功能恶化显著相关。有神经功能缺损或不稳定骨折的患者应接受固定手术治疗。
