本文選題：強直性脊柱炎　切入點：頸椎骨折　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討強直性脊柱炎(Ankylosing spondylitis)患者合并頸椎骨折的患病特點、治療方式及其臨床效果。方法:對37例AS合并頸椎骨折患者的臨床資料(2008.04-2016.01)進行回顧性分析并取得隨訪,整理分析隨訪信息及相關(guān)影像學資料,總結(jié)其臨床特點,評估患者神經(jīng)功能恢復情況及其預后。并依據(jù)美國脊髓損傷協(xié)會(ASIA)分級標準評價行手術(shù)治療者治療前后脊髓損傷改善情況,同時應用JOA頸椎評分標準和VAS評分標準對行手術(shù)治療者前后癥狀改善進行評分比較。行手術(shù)治療者術(shù)后隨訪根據(jù)平片、三維CT和MRI等影像學檢查綜合評估骨折的融合以及脊髓減壓情況。結(jié)果:37例患者,手術(shù)治療34例,保守治療3例。行手術(shù)治療者中,其中1例行一期前路,術(shù)后1周行二期前路翻修,聯(lián)合后路固定,隨訪時骨折獲得完全愈合,其余患者均行一期手術(shù),術(shù)后骨折部位均獲骨性融合,復位后頸椎排列序列良好,無再次移位、脫位發(fā)生。手術(shù)患者VAS評分從術(shù)前(9.03±0.72)分降至末次隨訪時(2.03±0.94)分,差異有統(tǒng)計學意義(p0.05);JOA評分從術(shù)前(6.53±3.20)分提高至末次隨訪時(12.97±3.68)分,差異有統(tǒng)計學意義(p0.05);術(shù)前術(shù)后ASIA分級的比較采用配對秩和檢驗對數(shù)據(jù)進行對比,差異有統(tǒng)計學意義(p0.05)。其中,單純一期前路與單純一期后路的兩組手術(shù),術(shù)前術(shù)后VAS、JOA評分比較,組間差異無統(tǒng)計學意義(p0.05);單純一期前路組患者手術(shù)時間(121.54±57.86)min、術(shù)中出血量(73.85±29.87)ml顯著少于單純一期后路組患者手術(shù)時間(181.39±61.30)min、術(shù)中出血量(314.44±331.73)ml,差異有統(tǒng)計學意義(P0.05)。結(jié)論:AS合并頸椎骨折絕大多數(shù)屬三柱骨折,是高度不穩(wěn)定性骨折。應盡早手術(shù)減壓和穩(wěn)定脊柱,最大限度的降低脊髓損傷的概率及程度。施行個性化治療,其術(shù)式、固定節(jié)段則根據(jù)患者病情發(fā)展階段及其影像學特點綜合選擇。
[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 鹵0.72 before operation to 2.03 鹵0.94 at the last follow-up, and the difference was statistically significant from 6.53 鹵3.20 before operation to 12.97 鹵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 鹵57.86 min, the intraoperative bleeding volume was 73.85 鹵29.87 ml, which was significantly lower than that in the primary stage group (181.39 鹵61.30 min), and the intraoperative bleeding volume was 314.44 鹵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.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R593.23;R683

【參考文獻】

相關(guān)期刊論文 前10條

1 朱康華;孟志斌;;計算機導航下經(jīng)椎弓螺釘內(nèi)固定治療強直性脊柱炎合并頸胸椎骨折7例[J];中華災害救援醫(yī)學;2016年03期

2 劉巖路;黃異飛;胡煒;;強直性脊柱炎頸椎骨折脫位治療的臨床體會(附3例報告)[J];新疆醫(yī)學;2015年10期

3 錢邦平;曲哲;邱勇;季明亮;張云鵬;胡俊;王斌;俞楊;朱澤章;;強直性脊柱炎患者頸椎新鮮骨折的臨床特征及術(shù)式選擇[J];中國脊柱脊髓雜志;2015年09期

4 呂穎;吳歆;徐滬濟;;骨質(zhì)疏松與強直性脊柱炎[J];中華風濕病學雜志;2014年10期

5 張瑤琴;;強直性脊柱炎合并下頸椎骨折圍手術(shù)期并發(fā)癥的觀察和預防[J];中國現(xiàn)代醫(yī)藥雜志;2014年02期

6 洪鋒;倪建平;;強直性脊柱炎下頸椎骨折的臨床回顧性分析[J];中國骨傷;2013年06期

7 郭宇松;靳曉波;高學峰;趙昌平;李增炎;;強直性脊柱炎合并脊柱骨折的臨床分析[J];河北醫(yī)科大學學報;2012年04期

8 黃玉國;李永民;申勇;;強直性脊柱炎脊柱骨折的臨床特點和手術(shù)治療策略[J];中國矯形外科雜志;2012年07期

9 左春光;張軍;王新虎;劉繼軍;王建順;張國華;;強直性脊柱炎患者頸椎骨折脫位繼發(fā)食管瘺1例報告[J];中國脊柱脊髓雜志;2010年09期

10 魏浩;陳維善;騰沖;;強直性脊柱炎下頸椎骨折治療進展[J];國際骨科學雜志;2010年01期

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