Hendrix R W, Melany M, Miller F, Rogers L F
Department of Radiology, Northwestern University School and Nortwestern Memorial Hospital, Chicago, IL 60611.
AJR Am J Roentgenol. 1994 Apr;162(4):899-904. doi: 10.2214/ajr.162.4.8141015.
Only 12 patients with a fracture through a portion of the spine ankylosed by diffuse idiopathic skeletal hyperostosis have been reported. The purpose of this study was to determine the types of causative trauma, spinal sites at risk for fracture, complications mortality, diagnostic difficulties, and abnormalities identified only with special imaging studies in a group of 15 patients with this complication seen at our institution.
The study included 15 patients with diffuse idiopathic skeletal hyperostosis who had a spinal fracture through an area of ankylosed spine. The criteria for diffuse idiopathic skeletal hyperostosis include flowing calcification or ossification along the anterolateral margin of at least four contiguous vertebral bodies; preservation of disk height in the involved areas; and absence of bony ankylosis of the apophyseal joint and erosion, sclerosis, or bony fusion of the sacroiliac joints. All spinal radiographs, tomograms, CT scans, and MR images obtained in these patients were reviewed to determine diagnostic difficulties, site and level of fracture, displacement of fractures, and extent of anatomic injury. The hospital charts of all patients were reviewed for history, physical examination, clinical status, treatment, and outcome.
Fourteen fractures of the cervical spine, one of the thoracic spine, and one of the lumbar spine occurred in 15 patients. Five fractures were caused by high-energy trauma and 11 fractures by low-energy, seemingly trivial injuries. The spinal fracture caused complete quadriplegia in seven patients, incomplete quadriplegia in one patient, complete paraplegia in two patients, a central cord syndrome in two patients, and no neurologic deficit in three patients. In two of three patients in whom fracture diagnosis was delayed, paraplegia developed during the delay. Three patients died within 1 week and three more died within 6 months after injury. CT and conventional tomography enabled diagnosis of posterior element fractures not seen on plain radiographs in five patients. All fractures healed, except those in the three patients who died within a week of injury.
Trivial trauma was the most common cause of fracture in the spine ankylosed by diffuse idiopathic skeletal hyperostosis. The severity of spinal cord injury in our patients was greater than in previous reports. We suggest that this may be a function of the relatively long segments of ankylosed spine (average, 16 vertebrae) in our patients providing a long lever arm for any traumatic force to act on. Patients with shorter ankylosed segments had less severe cord injuries. Delay in diagnosis of a fracture through an area of ankylosed spine associated with diffuse idiopathic skeletal hyperostosis was common if no neurologic deficit was present, and led to permanent paraplegia in two of three patients. CT and MR studies were useful in determining the anatomic abnormalities present, but were performed only in a limited number of patients.
据报道，仅有12例因弥漫性特发性骨肥厚导致脊柱部分强直并发生骨折的患者。本研究的目的是确定致伤创伤类型、脊柱骨折的危险部位、并发症、死亡率、诊断困难以及在我院就诊的15例患有此并发症患者中仅通过特殊影像学检查发现的异常情况。
本研究纳入15例弥漫性特发性骨肥厚患者，其脊柱骨折发生在强直脊柱区域。弥漫性特发性骨肥厚的诊断标准包括至少四个连续椎体前外侧缘有连续性钙化或骨化；受累区域椎间盘高度保留；小关节无骨性强直以及骶髂关节无侵蚀、硬化或骨性融合。对这些患者所获得的所有脊柱X线片、断层扫描、CT扫描和MR图像进行回顾，以确定诊断困难、骨折部位和节段、骨折移位情况以及解剖损伤程度。查阅所有患者的医院病历，了解其病史、体格检查、临床状况、治疗及预后情况。
15例患者中发生颈椎骨折14例、胸椎骨折1例、腰椎骨折1例。5例骨折由高能创伤引起，11例骨折由低能、看似轻微的损伤引起。脊柱骨折导致7例患者完全性四肢瘫、1例患者不完全性四肢瘫、2例患者完全性截瘫、2例患者出现中央脊髓综合征，3例患者无神经功能缺损。在3例骨折诊断延迟的患者中，有2例在延迟期间发生了截瘫。3例患者在受伤后1周内死亡，另外3例在受伤后6个月内死亡。CT和传统断层扫描能够诊断出5例平片上未见的后部结构骨折。除了在受伤后1周内死亡的3例患者外，所有骨折均愈合。
轻微创伤是弥漫性特发性骨肥厚导致脊柱强直患者骨折的最常见原因。我们患者的脊髓损伤严重程度高于以往报道。我们认为这可能与我们患者中强直脊柱的节段相对较长（平均16个椎体）有关，这为任何外力作用提供了较长的力臂。强直节段较短的患者脊髓损伤较轻。如果没有神经功能缺损，弥漫性特发性骨肥厚相关的强直脊柱区域骨折的诊断延迟很常见，并且在3例患者中有2例导致永久性截瘫。CT和MR研究有助于确定存在的解剖异常，但仅在少数患者中进行。
