CAJ | 학술논문

目的：探讨清醒麻醉＋平衡体位下手术治疗强直性脊柱炎（ AS ）合并脊柱骨折的疗效。方法回顾性分析自2006年1月～2011年1月，对33例强直性脊柱炎合并胸腰椎骨折患者采用清醒麻醉＋平衡体位下行手术治疗，其中AS合并颈椎损伤14例，合并胸腰椎骨折19例，AS合并颈椎骨折者，入院后即行Halo-vest固定于平衡体位，在Halo-vest保护下行颈椎前路或后路减压融合为手术，AS合并胸腰椎骨折患者维持患者平衡体位，在清醒麻醉下行后路长节段椎弓根螺钉固定融合手术，经过10～43个月（平均24个月）的随访，随访内容包括术后1周，3，6，12个月X线片、CT，局部疼痛缓解情况（VAS评分），植骨融合情况，内固定是否存在松动断裂现象，矫正角度有无丢失以及脊髓神经恢复情况（ Frankel分级）。结果所有患者均得到随访，16例脊髓损伤者，除1例无明显恢复外，神经功能均有恢复，33例患者骨折部位均骨性愈合，术后随访，无内固定松动断裂及矫正角度丢失，2例患者遗留胸背部疼痛（ VAS评分2分），给予消炎镇痛药物治疗后好转。结论清醒麻醉＋平衡体位下行手术治疗是治疗AS合并脊柱骨折的一种有效的方法。
목적：탐토청성마취＋평형체위하수술치료강직성척주염（ AS ）합병척주골절적료효。방법회고성분석자2006년1월～2011년1월，대33례강직성척주염합병흉요추골절환자채용청성마취＋평형체위하행수술치료，기중AS합병경추손상14례，합병흉요추골절19례，AS합병경추골절자，입원후즉행Halo-vest고정우평형체위，재Halo-vest보호하행경추전로혹후로감압융합위수술，AS합병흉요추골절환자유지환자평형체위，재청성마취하행후로장절단추궁근라정고정융합수술，경과10～43개월（평균24개월）적수방，수방내용포괄술후1주，3，6，12개월X선편、CT，국부동통완해정황（VAS평분），식골융합정황，내고정시부존재송동단렬현상，교정각도유무주실이급척수신경회복정황（ Frankel분급）。결과소유환자균득도수방，16례척수손상자，제1례무명현회복외，신경공능균유회복，33례환자골절부위균골성유합，술후수방，무내고정송동단렬급교정각도주실，2례환자유류흉배부동통（ VAS평분2분），급여소염진통약물치료후호전。결론청성마취＋평형체위하행수술치료시치료AS합병척주골절적일충유효적방법。
Objective To study the surgical treatment of vertebral fractures in ankylosing spondylitis by wa-king-up anaesthetization and balance position .Methods Thirty-three cases of vertebral fractures and ankylosing spondy-litis patients admitted in our hospital were studied retrospectively .There were 14 patients with Cervical vertebral fractures and ankylosing spondylitis and 19 patients with thoracolumbar vertebral fractures and ankylosing spondylitis in total .We operated by waking-up anaesthetization and balance position .Results All patients were followed up for 10 months to 43 months(average of 24 months).The X-ray,CT,local pain VAS scale,the mean angle of kyphosis correction ,looseness and displacement of screws and rods ,Frankel Grade improving were collected .Conclusion Surgical intervention by wa-king-up anaesthetization and balance position may be a properway to treat vertebral fractures in ankylosing spondylitis .