强直性脊柱炎的脊柱手术原因分析

发布时间：2018-08-19 19:09

【摘要】：目的:了解强直性脊柱炎(ankylosing spondylitis,AS)常见的脊柱手术原因,以便风湿科医师能够更好地为患者制定合理、有效的治疗方案,并普及患者教育。方法:回顾性收集北京大学第三医院自2007年1月至2013年7月在骨科住院并接受脊柱手术的79例AS患者的住院资料,其中男72例,女7例,根据患者手术原因进行总结分析。结果:手术部位以颈椎居多,为59例(74.7%),其他依次为胸腰椎、胸椎、颈胸椎及腰椎。常见的AS脊柱手术原因为骨折、脱位等不稳定因素(53.2%),其中骨折患者27例,多数为创伤所致,其次为脊髓或神经根压迫(34.1%),正畸(12.7%)并不是主要的手术原因。颈椎手术以颈椎病(25例)最多见,其次为颈椎骨折(22例),以颈7椎体骨折最多(8例),因颈椎脱位而手术的病例居第3位(10例)。颈椎手术中寰枢椎病变较常见(13例),主要病因为脱位、半脱位或不稳定,其次为骨折,寰枢椎手术患者的年龄及病程小于其他部位的颈椎手术患者。胸腰椎手术以胸腰椎后凸正畸手术最常见(10例),其次是骨折(6例),多发生于胸11~12椎体。根据入院时间将接受脊柱手术的AS患者按年份进行统计,2007—2008年最多为34例,2009—2010年为26例,2011—2013年7月仅19例,接受手术人数呈逐年递减趋势。结论:AS脊柱手术节段以颈椎为主,寰枢椎病变并不少见。AS脊柱手术的原因以骨折等脊柱不稳定病变和压迫症状为主,创伤因素也占相当比例。虽然接受脊柱手术的AS患者正逐年减少,但风湿科医师仍需加强对AS患者的早期诊疗及规范患者教育。
[Abstract]:Objective: to investigate the common causes of spinal surgery in ankylosing spondylitis (as), so that rheumatologists can make reasonable and effective treatment plan for patients and popularize patient education. Methods: the data of 79 patients with as who were hospitalized in orthopedic department from January 2007 to July 2013 in Peking University third Hospital were retrospectively collected, including 72 males and 7 females. Results: cervical vertebrae was the most common site, 59 cases (74.7%). The others were thoracolumbar vertebra, thoracic vertebra, cervical thoracic vertebra and lumbar vertebra. The common causes of as spinal surgery were fracture, dislocation and other unstable factors (53.2%). Most of the 27 cases were caused by trauma, followed by spinal cord or nerve root compression (34.1%), orthodontics (12.7%) was not the main operative cause. Cervical spondylosis (25 cases), cervical vertebra fracture (22 cases), cervical vertebrae fracture (8 cases) and cervical dislocation (10 cases) were the most common in cervical vertebra surgery. Atlantoaxial lesions were more common in cervical surgery (13 cases). The main causes were dislocation, subluxation or instability, followed by fracture. The age and course of atlantoaxial surgery were smaller than those in other parts of cervical vertebrae. Thoracolumbar spondylolysis orthodontic surgery was the most common (10 cases), followed by fracture (6 cases), mostly occurred in thoracic 1112 vertebrae. According to the time of admission, there were 34 patients with as undergoing spinal surgery in 2007-2008 and 26 patients in 2009-2010 and only 19 patients in July 2011-2013. The number of patients undergoing spinal surgery was decreasing year by year. Conclusion the cervical vertebrae is the main segment of as spinal surgery, and atlantoaxial lesions are not uncommon. The main causes of as spinal surgery are spinal instability and compression symptoms such as fractures, and trauma factors are also a significant proportion. Although the number of as patients undergoing spinal surgery is decreasing year by year, rheumatologists still need to strengthen the early diagnosis and treatment of as patients and standardize patient education.
【作者单位】：北京大学第三医院风湿免疫科;
【分类号】：R593.23;R687.3

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