First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
Spine (Phila Pa 1976). 2021 Jan 1;46(1):E31-E36. doi: 10.1097/BRS.0000000000003754.
Retrospective study.
A retrospective study was conducted to clarify the prognostic factors of postoperative for cervical spine fractures patients with ankylosing spondylitis (AS).
Now the high probability of cervical fractures in patients with AS is unanimously recognized. Fractures mostly occur in the lower cervical spine and two-thirds of patients are accompanied by spinal cord injury. But there are few studies on treatment of AS patients with cervical fracture and it is unclear whether the surgical method, timing of surgery, basic treatment of AS, and different doses of steroids therapy have an impact on the prognosis. Thus, this study aims to evaluate the impact of perioperative factors on the prognosis of traumatic cervical fractures in surgical patients with AS.
Preoperative and postoperative spinal cord function were assessed according to the Japanese Orthopaedic Association (JOA) Scores and Improvement rate were calculated. The neck pain severity were rated using a visual analogue scale (VAS) score. The t test and v2-test were used for comparison of clinical data between the preoperative and postoperative groups. Logistic univariate and multivariate regression analysis were used to obtain adjusted odds ratios. Pearson correlation coefficients were used to evaluate the relationship between variables.
The degree of fracture displacement in cervical spine fractures patients with AS was most common at the neck-chest junction (26.1%). Patients with degree of cervical fracture displacement less than 50% had significantly improved JOA scores after surgery (P = 0). The incidence of spinal cord injury (SCI) due to fracture was high (52.2%). Patients with combined anterior and posterior is helpful for neurological recovery (P = 0.01). Basic AS treating before injury would be benefit for neurological improvement (P = 0).
Basic AS treatment, SCI, and surgical methods are independent factors that affect the prognosis of cervical spine fractures patients with AS. It is controversial to perform surgery and preoperative steroid application as soon as possible.
回顾性研究。
本研究旨在明确强直性脊柱炎（AS）合并颈椎骨折患者术后的预后因素。
目前，AS 患者颈椎骨折的高概率已得到普遍认可。骨折多发生在下颈椎，三分之二的患者伴有脊髓损伤。但目前关于 AS 合并颈椎骨折患者的治疗研究较少，手术方式、手术时机、AS 的基础治疗以及不同剂量的类固醇治疗是否会影响预后尚不清楚。因此，本研究旨在评估围手术期因素对手术治疗 AS 合并颈椎骨折患者预后的影响。
根据日本矫形协会（JOA）评分评估术前和术后脊髓功能，并计算改善率。采用视觉模拟评分（VAS）评估颈部疼痛严重程度。采用 t 检验和卡方检验比较术前和术后组的临床资料。采用单因素和多因素 logistic 回归分析获得调整后的优势比。采用 Pearson 相关系数评估变量之间的关系。
AS 合并颈椎骨折患者的骨折移位程度最常见于颈胸交界处（26.1%）。颈椎骨折移位程度小于 50%的患者术后 JOA 评分显著提高（P=0.000）。骨折导致脊髓损伤（SCI）的发生率较高（52.2%）。前后联合入路有助于神经恢复（P=0.01）。损伤前进行 AS 基础治疗有助于神经改善（P=0.002）。
AS 基础治疗、SCI 和手术方式是影响 AS 合并颈椎骨折患者预后的独立因素。尽早手术和术前应用类固醇存在争议。
3 级。
