| 强直性脊柱炎合并胸腰椎骨折的临床分析 |
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投稿时间：2008-11-26
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| 作者 | Author | 单位 | Address | E-Mail |
| 刘欣 |
LIU Xin |
天津医院风湿骨病科,天津 300211 |
Department of Rheumatic and Osteoarthrosis,Tianjin Hospital,Tianjin 300211,China |
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| 白人骁 |
BAI Ren-xiao |
天津医院风湿骨病科,天津 300211 |
Department of Rheumatic and Osteoarthrosis,Tianjin Hospital,Tianjin 300211,China |
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| 李德达 |
LI De-da |
天津医院风湿骨病科,天津 300211 |
Department of Rheumatic and Osteoarthrosis,Tianjin Hospital,Tianjin 300211,China |
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| 朱波 |
ZHU Bo |
天津医院风湿骨病科,天津 300211 |
Department of Rheumatic and Osteoarthrosis,Tianjin Hospital,Tianjin 300211,China |
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| 吴疆 |
WU Jiang |
天津医院风湿骨病科,天津 300211 |
Department of Rheumatic and Osteoarthrosis,Tianjin Hospital,Tianjin 300211,China |
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| 期刊信息：《中国骨伤》2009年，第22卷，第7期，第488-490页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
| 基金项目: |
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中文摘要:
目的：总结强直性脊柱炎合并胸腰椎骨折的临床特点，避免诊断延误。
方法：回顾性分析自2005年4月至2007年6月收治的5例强直性脊柱炎合并胸腰椎骨折病例，男4例，女1例；年龄26～72岁，平均44.8岁。分析内容包括：病史、骨性融合椎体数、骨折特点、风湿活动状态等。
结果：强直性脊柱炎患病史平均22.6年。骨性融合椎体数平均18.2节。1例为自驾车交通事故，1例有扭伤史，3例无外伤史为应力骨折。2例合并椎体骨折：骨折线分别经T6、T7或L1椎体；3例合并椎间隙骨折：2例骨折线经L1,2椎间隙，1例骨折线经L2,3椎间隙。未见压缩骨折及脊髓或马尾神经损伤。4例血沉及C-反应蛋白等急性炎症指标与疼痛程度不相称。非甾体抗炎药均无明显止痛效果。在外院均误诊为强直性脊柱炎“复发”,平均延误1.51个月。
结论：①骨折好发于强直性脊柱炎中晚期胸腰椎广泛骨性融合者；②好发于下部胸椎和上部腰椎，且多为应力骨折；③可以为合并椎体骨折或椎间隙骨折；④易误认为强直性脊柱炎“复发”而发生误诊、漏诊；⑤中晚期强直性脊柱炎患者腰背痛突然加剧，疼痛程度与急性炎症指标不相称，非甾体抗炎药甚至皮质类固醇疗效欠佳，应考虑到胸腰椎骨折可能。 |
| 【关键词】脊柱炎,强直性 胸椎 腰椎 骨折 |
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| Analysis of the thoracolumbar fracture with ankylosing spondylitis |
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ABSTRACT
Objective: To review the clinical features of the thoracolumbar fracture with ankylosing spondylitis (AS) in order to avoid delayed or missed diagnosis.
Methods: Five patients of thoracolumbar fracture with AS treated from April 2005 to June 2007 in our department were studied retrospectively,male 4 cases,female 1 case,the age from 26 to 72 years old with an average of 44.8 years. Analysis including:case history,number of the ankylosed vertebras,characteristic of fracture,active state rheumatism.
Results: The patients had the history of AS for average 22.6 years. The mean number of the ankylosed vertebras was 18.2. Of the 5 cases,1 case encountered traffic accident,1 case was sprained,and 3 cases without trauma were diagnosed as stress fracture. Two cases were trans-vertebra fracture:the fracture line was through T6,T7,or L1 vertebral body respectively;3 cases were through the disc space:2 cases were through L1,2 disc space,1 case was through L2,3. No compression fracture and neurological injury were found. The acute inflammatory index such as ESR and CRP in 4 cases didn't correlate with the degree of pain. The non-steroidal anti-inflammatory drugs(NSAIDs) hadn't significant effectiveness in relieving pain. The patients were diagnosed as'relapse'of AS in other hospital,and had been misdiagnosed for average 1.51 months.
Conclusion: ①the fr- acture is prevalent at the middle or late period of AS when extensive ankylosis has been existed at the thoracolumbar region;② the fracture is common at the lower thoracal spine and the upper lumbar spine,and the majority is the stress fracture;③ the fra- cture line may be through the vertebral body,but more often through the disc space;④ it is like an exacerbation of AS and the- refore to be missed diagnosis;⑤ when the back pain exacerbated suddenly in the middle or late period of AS,the degree of pa- in not correlating with acute inflammatory index,and the NSAIDs ineffective,the thoracolumbar fracture should be considered. |
| KEY WORDS pondylitis,ankylosing Thoracic vertebrae Lumbar vertebrae Fractures |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 刘欣,白人骁,李德达,朱波,吴疆.强直性脊柱炎合并胸腰椎骨折的临床分析[J].中国骨伤,2009,22(7):488~490 |
| 英文格式: | LIU Xin,BAI Ren-xiao,LI De-da,ZHU Bo,WU Jiang.Analysis of the thoracolumbar fracture with ankylosing spondylitis[J].zhongguo gu shang / China J Orthop Trauma ,2009,22(7):488~490 |
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