摘要目的 探讨合并颈胸段后凸畸形强直性脊柱炎颈椎骨折的手术方法.方法 回顾性分析2007年1月至2014年8月行手术治疗的合并颈胸段后凸畸形的强直性脊柱炎颈椎骨折患者21例,男20例,女1例;年龄36～65岁,平均(48.6±7.5)岁.术前美国脊柱损伤协会(American spinal injury association,ASIA)脊髓损伤分级:A级2例、B级6例、C级7例、D级5例、E级1例.接受颈后路切开复位(减压)固定融合术或后前入路联合减压植骨融合内固定术.记录手术时间、出血量,疗效评价采用疼痛视觉模拟评分(visual analogue scale,VAS)、ASIA分级、颈椎曲度及影像学情况.结果 20例患者获得随访,随访时间25～59个月,平均(39.4±8.76)个月;另1例因肺部感染及呼吸衰竭于术后第45天死亡.接受颈后路切开复位固定融合术者7例,手术时间平均为(92.1±5.4) min、失血量平均为(96.1+23.7) ml;接受颈后路切开复位减压固定融合者9例,手术时间为(121.4±14.0) min、失血量为(250.0±38.9) ml;接受后前入路联合减压植骨融合内固定术者5例,手术时间为(222.4±14.9) min、失血量为(354.3+46.7) ml.术后3个月VAS评分平均为(2.76±0.46)分,较术前[(8.95±0.36)分]明显降低;术后24个月平均为(1.77±0.39)分,较术后3个月明显降低.术后脊髓神经功能改善明显,随访期间继续恢复,术后24个月ASIA分级:A级0例、B级0例、C级3例、D级8例、E级9例.术后颈椎曲度由术前平均-13.4°±3.3°恢复至-7.1°±1.9°,术后24个月时无明显丢失.20例患者植骨均融合,融合时间4～9个月,平均5.8个月.随访期间无内植物松动、移位及断裂现象.结论 颈后路切开复位(减压)固定融合术及后前入路联合手术均可明显缓解患者症状,有效恢复颈椎序列及明显改善患者的神经功能.

abstractsObjective To discuss the operative strategies for cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic kyphosis.Methods Retrospectively analyzed 21 cases of cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic kyphosis,who underwent surgeries from January,2007 to August,2014.Twenty males and 1 female were included.Mean age was (48.6±7.5) years (range,36-65 years).The preoperative American Spine Injury Association (ASIA) classification distribution:2 cases of Grade A,6 cases of Grade B,7 cases of Grade C,5 cases of Grade D,and 1 case of of Grade E.The investigative surgical methods including posterior cervical open reduction,internal fixation and bone graft fusion;posterior cervical open reduction/decompression,internal fixation and bone graft fusion;or combined posterior and anterior cervical decompression,bone graft fusion and instrumentation.The operative time and blood loss were recorded,the clinical therapeutic effect was evaluated by visual analogue scale (VAS) score,ASIA grade improvement,cervical curvature (the angle between a line drawn parallel to the inferior endplate of C2 and a line drawn parallel to the inferior endplate of C7 in the lateral plane of an X-ray image) and radiological assessment (including bone graft fusion condition and internal fixation position).Results One case died from severe pulmonary infection and respiratory failure at the 45th day after operation.All the other 20 patients obtained complete follow-up with a mean time of (39.4±8.76) months (range,25-59 months).7 cases received posterior cervical open reduction,internal fixation and bone graft fusion,average operative time was (92.1±5.4) minutes and average blood loss was (96.1+23.7) ml.9 cases received the posterior cervical open reduction and decompression,internal fixation and bone graft fusion,mean operation time was (121.4± 14.0) minutes and blood loss was (250.0±38.9) ml.3 cases experienced combined posterior and anterior cervical decompression,bone graft fusion and fixation,average operative time was (222.4± 14.9) minutes and average blood loss was (354.3+46.7) ml.Mean of VAS scores at the 3th month postoperatively was 2.76±0.46,significantly lower than the preoperatively VAS scores (8.95±0.36).Mean of VAS scores at the 24th month postoperatively was 1.77±0.39,significantly lower than those at the 3th month postoperatively.The neurological function of spinal cord achieved significant improvement after operations and continued recovered gradually in the subsequent follow up.ASIA Classification distribution at the 24th month postoperatively was:0 case of Grade A,0 case of Grade B,3 cases of Grade C,8 cases of Grade D,9 case of Grade E.Mean of the cervical curvature after operation was-7.1°± 1.9°,significantly higher than preoperatively(-13.4°±3.3°) and did not have any loss of Cobb's angles at 24th month after operation.All the surviving cases achieved solid bone graft fusion.Mean bone graft fusion time was 5.8 months (range,4-9 months).There was no internal fixation loose,fracture and dislocation occurred during follow up.Conclusion All procedures can significantly relieve the painful symptoms,effectively restore the normal cervical alignment and stability,and remarkably improve the neural function of the patients suffering cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic junction kyphosis.