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目的：分析强直性脊柱炎（AS）合并颈椎骨折患者的临床特点和手术方式。方法：回顾性纳入2017年1月至2023年12月山东第一医科大学附属省立医院行手术治疗的52例AS合并颈椎骨折患者。记录患者年龄、性别、损伤机制、颈椎骨折部位，是否合并颈椎脱位、后纵韧带骨化，是否发生脊髓损伤，临床病症，手术方式；并根据术后疼痛视觉模拟评分（VAS）及美国脊髓损伤协会（ASIA）分级评估治疗效果，同时观察患者术后并发症发生情况。结果：52例AS合并颈椎骨折患者，男45例，女7例；年龄32～68岁，平均年龄（50.54±7.33）岁；低能量创伤患者22例，高能量创伤患者30例。患者以颈部疼痛为主要症状，最常见的骨折部位为C5～7节段。根据患者是否发生脊髓损伤分为脊髓损伤组42例和无脊髓损伤组10例，脊髓损伤组患者颈椎脱位和后纵韧带骨化情况均高于无脊髓损伤组患者，差异有统计学意义（P均<0.05）。44例行切开复位内固定术（颈椎前路2例，颈椎后路34例，前后联合入路8例），8例行外固定术（均采用Halo-Vest支架）。与术前比较，术后5 d,9例患者神经功能得到改善；术后6个月随访时，16例患者神经功能得到改善。VAS评分由术前（7.31±0.28）分改善至术后5 d(3.54±0.18)分和术后6个月（1.94±0.13）分，差异均有统计学意义（P均<0.05）。接受内固定术治疗的患者中，有6例术后出现脑脊液漏、肺部感染、尿路感染、伤口愈合缓慢；接受外固定术治疗的患者中，有4例出现局部疼痛，均经对症治疗后好转。结论：低能量创伤可导致AS患者发生颈椎骨折及脊髓损伤，手术治疗可有效增强颈椎稳定性、恢复脊髓功能，注重合并症及并发症的管理有利于患者的康复。
Abstract：Objective: To analyze the clinical characteristics and surgical methods in patients with ankylosing spondylitis(AS) complicated by cervical spine fractures. Methods: A retrospective study was conducted on 52 patients with AS and cervical spine fractures who underwent surgical treatment at Shandong Provincial Hospital Affiliated to Shandong First Medical University between January 2017 and December 2023. Data on patient age, gender, injury mechanism, fracture location, presence of cervical dislocation, ossification of the posterior longitudinal ligament, spinal cord injury, clinical manifestations, and surgical approaches were recorded. Postoperative complications were monitored, and therapeutic outcomes were assessed using the Visual Analogue Scale(VAS) for pain and the American Spinal Injury Association(ASIA) impairment scale. Results: Among the 52 patients, 45 were male and 7 were female, with a mean age of 50.54±7.33 years(range: 32-68). Low-energy trauma was identified in 22 cases and high-energy trauma in 30 cases. Neck pain was the predominant symptom, and the most common fracture site was the C5-C7 segment. Based on the presence of spinal cord injury(SCI), patients were divided into an SCI group(n=42) and a non-SCI group(n=10). The incidence of cervical dislocation and ossification of the posterior longitudinal ligament was significantly higher in the SCI group than in the non-SCI group(both P<0.05). Open reduction and internal fixation were performed in 44 patients(2 via the anterior approach, 34 via the posterior approach, and 8 via combined anterior-posterior approach), while 8 patients underwent external fixation with a HALO-Vest brace. Compared with preoperative assessments, neurological improvement was observed in 9 patients at 5 days postoperatively and in 16 patients at the 6-month follow-up. The VAS score significantly improved from 7.31±0.28 preoperatively to 3.54±0.18 at 5 days postoperatively and to 1.94±0.13 at 6 months postoperatively(both P<0.05). Among patients who received internal fixation, 6 experienced postoperative complications, including cerebrospinal fluid leakage, pulmonary infection, urinary tract infection, and delayed wound healing. In the external fixation group, 4 patients reported local pain. All complications resolved after symptomatic treatment. Conclusions: In patients with AS, even low-energy trauma can cause cervical spine fractures and SCI; thus, surgical treatment is essential to stabilize the cervical spine and restore neurological function, while diligent management of comorbidities and complications is vital for successful rehabilitation.
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基本信息:
DOI：
中图分类号:R687.3;R593.23
引用信息:
[1]李慈,董金磊,卢舜等.强直性脊柱炎合并颈椎骨折患者的临床特点及手术方式[J].中华骨与关节外科杂志,2025,18(09):788-794.
基金信息:
山东省自然科学基金项目（ZR2023QH298）; 山东省重点研发计划（2021SFGC0502）; 国家重点研发计划（2023YFC2508801-2）