强直性脊柱炎合并脊柱骨折的临床与影像特点

胡嘉文; 冀肖健; 陈双萍; 张江林

doi:10.3969/j.issn.2095-5227.2022.01.007

强直性脊柱炎合并脊柱骨折的临床与影像特点

Clinical and imaging features of spinal fractures in ankylosing spondylitis

摘要

摘要:
背景合并脊柱骨折的强直性脊柱炎(ankylosing spondylitis，AS)患者逐年增多，临床上极易延误诊治，相关研究多为个案报道或小样本研究，缺乏大样本的回顾性研究。
目的探讨AS合并脊柱骨折的临床表现及影像学特点。
方法回顾性分析2008年1月- 2020年12月于解放军总医院第一医学中心住院就诊的AS合并脊柱骨折患者的临床资料。
结果研究共纳入102例患者，男性占83.3%，平均年龄(49.6±12.9)岁，平均病程(18.7±9.3)年。其中自发性骨折43例(42.2%)，最常累及胸椎、腰椎(各25例，58.1%)；创伤性骨折59例(57.8%)，最常累及颈椎(26例，44.1%)。AS特征性骨桥骨折共14例，最常累及腰椎(11例，78.6%)，确诊骨桥骨折需行CT及三维重建。本组研究中有10例Andersson骨折，影像学检查显示椎间盘破坏及真空征。
结论合并脊柱骨折的AS患者多为中老年男性，病程较长。对于有疼痛性质改变的此类患者，应警惕脊柱骨折的发生。椎体间有多发骨桥形成的患者，容易出现自发性骨桥骨折，仅凭X线检查难以诊断，需行CT平扫+三维重建检查。Andersson骨折通常累及三柱，可能被误诊为结核或感染，应注意鉴别。

Abstract:
Background The number of ankylosing spondylitis (AS) patients with spinal fracture is increasing year to year, and it is easy to delay diagnosis and treatment. However, most of the correlative studies are case reports or small sample studies, retrospective studies with relatively large number of patients are still lacking.
Objective To investigate the clinical characteristics and imaging features of AS patients with spinal fractures.
Methods From January 2008 to December 2020, clinical data about AS patients with spinal fracture admitted to the First Medical Center of Chinese PLA General Hospital were retrospectively analyzed.
Results A total of 102 patients were included in our study, with male patients accounted for 83.3%. The average age was (49.6±12.9) years and the average course of disease was (18.7±9.3) years. Forty-three patients (42.2%) had a spontaneous fracture, and thoracic and lumbar vertebra (25 cases, 58.1%) were the most common regions to be involved. Fifty-nine patients (57.8%) had a traumatic fracture, and cervical vertebra (26 cases, 44.1%) was the most common region to be involved. Fourteen patients had inter-vertebral bridge fracture, and lumbar vertebra (11 cases, 78.6%) was the most common regions to be involved. These fractures could only be diagnosed with the help of CT scans with three-dimensional reconstruction. Ten patients had Andersson fractures, imaging examination showed intervertebral disc destruction and visible vacuum sign.
Conclusion AS patients with spinal fracture are mostly elderly men with long course of disease. More attention should be paid to the patients presenting with changed pain properties. Patients with inter-vertebral bridge formation in spine are easily to have spontaneous fractures, and they are difficult to be diagnosed correctly on X-ray examinations, therefore, CT with 3D reconstruction are strongly recommended. Andersson fractures often involve three pillars and might be misdiagnosed as tuberculosis or infection, thus we should pay more attention to it.

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