CLINICAL FEATURES AND TREATMENTS OF CERVICAL FRACTURE IN ANKYLOSING SPONDYLITIS
Objective To examine the clinical characteristics,surgical methods and treatment efficacy for cervical fracture in patients with ankylosing spondylitis.Methods The clinical data of 21 ankylosing spondylitis patients with cervical fracture from May 2007 to May 2015 were retrospectively analyzed.These patients received either surgical treatment (20 patients) or conservative treatment (1 patient).The surgical procedures included single anterior decompression and fusion with internal fixation (3 patients with short segment fixation,and 2 patients with long segment fixation),single posterior decompression and fusion with internal fixation (13 patients),and combined anteroposterior approach (2 patients).Fracture fusion and spinal decompression were evaluated by X-ray,three dimensional CT and MRI at the final follow-up,and improvement in spinal cord injury was assessed according to the American Spinal Injury Association (ASIA) Classification.Results All of the 21 patients were followed up for 12 to 36 months (mean 28 months).The screw and steel plate became loose in two patients after anterior cervical short segment fixation surgery.In particular,the screw and steel plate were slightly shifted in one patient without exacerbating neurological deterioration,and satisfactory bone fusion was achieved following subsequent conservative treatment.The other patient received secondary anterior repair combined with posterior fixation,and showed satisfactory bone fusion at final follow-up.The rest of the patients all had satisfactory bone restoration and fusion,with fine cervical spine alignment and no recurrent spinal shift (dislocation).Among the 18 patients with spinal cord injury,neurological function was not recovered in 2 patients with complete spinal cord injury after the surgery,but the average ASIA of the remaining 16 patients with incomplete spinal cord injury was improved by 1-2 grades.Conclusion The posterior long segment fixation and fusion is effective in treating ankylosing spondylitis with cervical fracture,and concurrent posterior decompression is necessary for patients with nerve injury.
NETL
NSTL
万方数据
维普
