Chen Stephen Ryan, Munsch Maria Amelia, Chen Joseph, Couch Brandon Keith, Wawrose Richard Alan, Oyekan Anthony Abimbade, Adjei Joshua, Donaldson William F, Lee Joon Yung, Shaw Jeremy DeWitt
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Pittsburgh Orthopaedic Spine Research (POSR) Group, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Asian Spine J. 2023 Jun;17(3):549-558. doi: 10.31616/asj.2022.0155. Epub 2023 Feb 13.
Retrospective review of prospectively collected cohort.
To identify differences in treatment and mortality of spine fractures in patients with ankylosing conditions of the spine.
Ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are the two most common etiologies of ankylosing spinal disorder (ASD). However, studies on the treatment and outcomes of spine fractures in AS and DISH patients remain few.
Patients presenting with a spine fracture were diagnosed with AS or DISH at a single tertiary care center between 2010 and 2019. We excluded those who lacked cross-sectional imaging or fractures occurring at spinal segments affected by ankylosis, as well as polytraumatized patients. Patient demographics, injury mechanism, fracture level, neurologic status, treatment, and 1-year mortality were recorded. Computed tomography imaging was reviewed by two independent readers and graded according to the indicated AO Spine Injury Classification System. Differences in fracture severity, treatment method, and mortality were examined using Student t -tests, chi-square tests, and two-proportion Z-tests with significance set to p <0.05.
We identified 167 patients with spine fracture diagnosed with AS or DISH. Patients with AS had more severe fractures and more commonly had surgery than patients with DISH (p <0.001). Despite these differences, 1-year mortality did not significantly differ between AS and DISH patients (p =0.14).
Although patients with AS suffered more severe fractures compared to DISH and more frequently underwent surgery for these injuries, outcomes and 1-year mortality did not differ significantly between the two groups. For patients with ASDs and fractures, outcomes appear similar regardless of treatment modality. Consequently, there may be an opportunity for critical reappraisal of operative indications in ASD and a larger role for nonoperative management in these challenging patients.
对前瞻性收集的队列进行回顾性分析。
确定脊柱强直患者脊柱骨折治疗及死亡率的差异。
强直性脊柱炎（AS）和弥漫性特发性骨肥厚（DISH）是脊柱强直疾病（ASD）的两种最常见病因。然而，关于AS和DISH患者脊柱骨折治疗及结果的研究仍然较少。
2010年至2019年间，在一家三级医疗中心诊断为脊柱骨折且患有AS或DISH的患者纳入研究。我们排除了那些缺乏横断面影像资料的患者、发生在脊柱强直节段的骨折患者以及多发伤患者。记录患者的人口统计学资料、损伤机制、骨折节段、神经功能状态、治疗方法及1年死亡率。由两名独立阅片者对计算机断层扫描影像进行评估，并根据AO脊柱损伤分类系统进行分级。采用学生t检验、卡方检验和双比例Z检验分析骨折严重程度、治疗方法和死亡率的差异，显著性水平设定为p<0.05。
我们共纳入167例诊断为AS或DISH的脊柱骨折患者。与DISH患者相比，AS患者骨折更严重，手术治疗更为常见（p<0.001）。尽管存在这些差异，但AS和DISH患者的1年死亡率无显著差异（p = 0.
