强直性脊柱炎合并颈椎骨折的临床特点及治疗研究

发布时间：2018-03-20 18:21

本文选题：强直性脊柱炎　切入点：颈椎骨折　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨强直性脊柱炎(Ankylosing spondylitis)患者合并颈椎骨折的患病特点、治疗方式及其临床效果。方法:对37例AS合并颈椎骨折患者的临床资料(2008.04-2016.01)进行回顾性分析并取得随访,整理分析随访信息及相关影像学资料,总结其临床特点,评估患者神经功能恢复情况及其预后。并依据美国脊髓损伤协会(ASIA)分级标准评价行手术治疗者治疗前后脊髓损伤改善情况,同时应用JOA颈椎评分标准和VAS评分标准对行手术治疗者前后症状改善进行评分比较。行手术治疗者术后随访根据平片、三维CT和MRI等影像学检查综合评估骨折的融合以及脊髓减压情况。结果:37例患者,手术治疗34例,保守治疗3例。行手术治疗者中,其中1例行一期前路,术后1周行二期前路翻修,联合后路固定,随访时骨折获得完全愈合,其余患者均行一期手术,术后骨折部位均获骨性融合,复位后颈椎排列序列良好,无再次移位、脱位发生。手术患者VAS评分从术前(9.03±0.72)分降至末次随访时(2.03±0.94)分,差异有统计学意义(p0.05);JOA评分从术前(6.53±3.20)分提高至末次随访时(12.97±3.68)分,差异有统计学意义(p0.05);术前术后ASIA分级的比较采用配对秩和检验对数据进行对比,差异有统计学意义(p0.05)。其中,单纯一期前路与单纯一期后路的两组手术,术前术后VAS、JOA评分比较,组间差异无统计学意义(p0.05);单纯一期前路组患者手术时间(121.54±57.86)min、术中出血量(73.85±29.87)ml显著少于单纯一期后路组患者手术时间(181.39±61.30)min、术中出血量(314.44±331.73)ml,差异有统计学意义(P0.05)。结论:AS合并颈椎骨折绝大多数属三柱骨折,是高度不稳定性骨折。应尽早手术减压和稳定脊柱,最大限度的降低脊髓损伤的概率及程度。施行个性化治疗,其术式、固定节段则根据患者病情发展阶段及其影像学特点综合选择。
[Abstract]:Objective: to investigate the characteristics, treatment and clinical effects of ankylosing spondylitis in patients with ankylosing spondylitis. Methods: the clinical data of 37 patients with as complicated with cervical vertebra fracture were retrospectively analyzed and followed up. To analyze the follow-up information and related imaging data, and summarize the clinical characteristics, To evaluate the recovery of neurological function and its prognosis, and to evaluate the improvement of spinal cord injury before and after treatment according to the American Spinal Cord injury Association (ASIAA) grading standard. At the same time, JOA cervical spine score and VAS score were used to evaluate the improvement of symptoms before and after operation. Three dimensional CT and MRI were used to evaluate the fusion of fracture and decompression of spinal cord. Results among 37 cases, 34 cases were treated surgically and 3 cases were treated conservatively. One week after operation, the fracture was completely healed with the second stage anterior revision, combined with posterior fixation, and all the other patients underwent primary operation. All the patients had bone fusion at the fracture site, and the cervical vertebrae was arranged in good sequence after reduction, and there was no redisplacement. The VAS score of the patients decreased from 9.03 卤0.72 before operation to 2.03 卤0.94 at the last follow-up, and the difference was statistically significant from 6.53 卤3.20 before operation to 12.97 卤3.68 at the last follow-up. The difference was statistically significant (P < 0.05). The comparison of ASIA grades before and after operation was carried out by paired rank sum test, and the difference was statistically significant (p 0.05). Among them, the preoperative and postoperative ASIA scores were compared between the two groups with only one stage anterior approach and only one stage posterior approach. There was no significant difference between the two groups (p 0.05), and the operation time was 121.54 卤57.86 min, the intraoperative bleeding volume was 73.85 卤29.87 ml, which was significantly lower than that in the primary stage group (181.39 卤61.30 min), and the intraoperative bleeding volume was 314.44 卤331.73 ml, the difference was statistically significant (P 0.05). The fractures of the vertebrae are mostly three-column fractures. Is a highly unstable fracture. Decompression and stabilization of the spine should be performed as early as possible to minimize the probability and extent of spinal cord injury. The fixed segment was selected synthetically according to the stage of the patient's disease and its imaging features.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.23;R683

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