CAJ | 학술논문

目的探讨强直性脊柱炎(ankylosingspondylitis，AS)合并下颈椎骨折脱位的临床特点及手术治疗要点。方法2010年2月至2013年12月，我科共收治21例AS合并脊柱骨折患者，其中下颈椎骨折7例( C5～6椎骨折脱位1例，C6～7骨折脱位6例)：男6例，女1例，年龄平均47.8(40～52)岁。对7例均行手术治疗，采用单纯前路植骨融合内固定手术治疗1例，单纯后路手术长节段固定融合术治疗1例，前后联合入路手术治疗5例。结果7例术后获得平均18.2(6～34)个月随访。术中术后均未出现神经损害症状加重情况，手术切口均I期愈合；术后脑脊液漏1例，换药对症处理2周后愈合。1例C5～6椎骨折脱位患者行前路手术后第2天出现内固定移位，急诊行前后联合入路翻修术；6例术后神经功能较术前明显改善，1例无明显改善(术前为FrankelB级)。随访期间均达骨性融合，未出现内固定松动断裂移位现象。结论 AS脊柱骨折好发于颈胸交界区，大多合并有脊髓损伤，手术方式上宜行前后联合入路复位固定或后路长节段固定植骨融合术，术中应先充分减压后再精细复位，避免加重神经损伤。
목적탐토강직성척주염(ankylosingspondylitis，AS)합병하경추골절탈위적림상특점급수술치료요점。방법2010년2월지2013년12월，아과공수치21례AS합병척주골절환자，기중하경추골절7례( C5～6추골절탈위1례，C6～7골절탈위6례)：남6례，녀1례，년령평균47.8(40～52)세。대7례균행수술치료，채용단순전로식골융합내고정수술치료1례，단순후로수술장절단고정융합술치료1례，전후연합입로수술치료5례。결과7례술후획득평균18.2(6～34)개월수방。술중술후균미출현신경손해증상가중정황，수술절구균I기유합；술후뇌척액루1례，환약대증처리2주후유합。1례C5～6추골절탈위환자행전로수술후제2천출현내고정이위，급진행전후연합입로번수술；6례술후신경공능교술전명현개선，1례무명현개선(술전위FrankelB급)。수방기간균체골성융합，미출현내고정송동단렬이위현상。결론 AS척주골절호발우경흉교계구，대다합병유척수손상，수술방식상의행전후연합입로복위고정혹후로장절단고정식골융합술，술중응선충분감압후재정세복위，피면가중신경손상。
Objective To explore the clinical characteristics and surgical treatment of lower cervical spine fractures and dislocations combined with ankylosing spondylitis ( AS ).Methods From February 2010 to December 2013, 21 patients with AS combined with spinal fractures were adopted, including 7 patients with lower cervical spine fractures. There were 6 males and 1 female, whose average age was 47.8 years old ( range: 40-52 years ). All the 7 patients underwent surgical treatment, including 1 patient with C5-6 fractures and dislocations and 6 patients with C6-7 fractures and dislocations. Simple anterior interbody fusion and internal ifxation was performed on 1 patient, simple posterior long-segmental ifxation and fusion on 1 patient, and a combined anterior-posterior approach on the other 5 patients.Results All the 7 patients were followed up for a mean period of 18.2 months ( range: 6-34 months ). There was no aggravation of neuronal damage during and after the operation, and primary healing of surgical incisions was achieved in all the patients. Cerebrospinal lfuid leakage was noticed in 1 patient, who recovered after 2 weeks of changing dressing. Internal ifxation loosening was found in 1 patient with C5-6 fractures and dislocations at the 2nd day after the anterior surgery, and a combined anterior-posterior revisional operation was performed immediately. The remarkable improvement of the neuronal function was obtained in 6 patients after the operation, and no obvious improvement in 1 patient ( Frankel grade B preopertively ). Bone fusion was achieved in all the patients, without loosening, breakage or displacement of internal fixation during the follow-up.Conclusions The lower cervical vertebrae is the common location of AS and spinal fractures, usually combined with spinal cord injury ( SCI ). A combined anterior-posterior reduction and posterior long-segmental ifxation and bone graft fusion are 2 satisfactory surgical methods. The aggravation of neuronal damage can be effectively avoided, with complete decompression before ifne reduction.