Gougeon J, Rampon S, Deshayes P, Bussière J L, Seignon B, Le Loet X, Lopitaux R, Golenzer C
Rev Rhum Mal Osteoartic. 1977 Jan;44(1):17-25.
In three cases of rheumatic spondylitis, fracture across the disc of an ankylosed spinal segment (C5-C6, D7-D8, and D12-L1 respectively) resulted in rapid development of a discopathy with destruction of the adjacent vertebral bodies. In one of these cases, surgical exposure of the focus permitted anatomical study of the lesion; the changes that had developed after the fracture were inflammatory in appearance, which at first suggested infection by non-specific micro-organisms, an assumption that was rapidly abandoned. This misleading histological appearance largely explains why these destructive discopathies in spondylitis have long been regarded as a consequence of the rheumatic process itself. A review is presented of the arguments which suggest that they have, in fact, a mechanical pathogenesis, often determined by a fracture. From this it may be concluded that the treatment of choice is temporary immobilization in moderate cases and surgery with transplantation in complicated or unstable cases.
在3例风湿性脊柱炎患者中，分别在融合的脊柱节段（分别为C5 - C6、D7 - D8和D12 - L1）的椎间盘处发生骨折，导致椎间盘病迅速发展，并伴有相邻椎体破坏。在其中1例病例中，通过手术暴露病灶可对病变进行解剖学研究；骨折后出现的变化在外观上具有炎症性，起初提示为非特异性微生物感染，但这一假设很快被摒弃。这种具有误导性的组织学表现很大程度上解释了为什么脊柱炎中的这些破坏性椎间盘病长期以来一直被视为风湿过程本身的结果。本文对一些观点进行了综述，这些观点表明它们实际上具有机械性发病机制，通常由骨折所决定。由此可以得出结论，对于中度病例，首选治疗方法是临时固定；对于复杂或不稳定病例，则采用移植手术治疗。
