后路360°植骨融合治疗强直性脊柱炎胸腰椎应力骨折的临床研究

A single posterior surgical procedure of 360-degree intervertebral fusion for thoracolumbar stress fractures in ankylosing spondylitis

摘要:

目的  探讨单纯后路360°植骨融合内固定治疗强直性脊柱炎（AS）胸、腰椎应力骨折的手术方法及治疗效果。方法  对13例AS胸、腰椎应力骨折行后路360°植骨融合内固定患者行回顾性分析及随访。其中，3例行单侧关节突切除，经椎间孔入路椎间植骨+后外侧植骨椎弓根系统内固定；4例行单节段或多节段V形截骨（SPO）手术，经椎间孔椎间植骨+椎间融合器置入，后路椎弓根系统加压矫正脊柱后凸；6例伴明显后凸患者行假关节远端邻椎改良经椎弓根截骨术（PSO）+椎间植骨+椎间融合器置入，后路椎弓根系统矫正后凸畸形。结果  术后患者腰腿痛症状明显好转，后凸Cobb角平均矫正33°。2例并发脑脊液漏，无深部感染及神经系统并发症。术后平均31个月随访显示，假关节部位全部骨性愈合，无椎弓根钉棒断裂、松脱发生。结论  AS胸、腰椎应力骨折为三柱骨折，极不稳定，应行积极手术治疗。经后路固定，椎间孔入路行椎间植骨可达360°融合目的，手术安全可靠。经后路放置椎间融合器可增加椎间融合率，并有利于后凸畸形矫正。伴严重后凸畸形患者，同时行假关节部位椎体截骨，可有效矫正后凸畸形。

Abstract:

Objective To investigate the operative strategies of posterior 360-degree intervertebral fusion procedure for thoracolumbar stress fractures in the patients with ankylosing spondylitis. Methods Thirteen cases of thoracolumbar stress fractures in ankylosing spondylitis were retrospectively analyzed and followed up. Three of the patients were treated with the single surgical procedure of posterior transforaminal interbody fusion and posterolateral fusion and fixation. Four patients were operated with 360-degree intervertebral fusion and kyphosis correction by interbody TLIF cage placement and SPO procedure. The other six patients with serious kyphosis undertook the 360-degree intervertebral fusion combined with transvertebral modified PSO procedure in order to make better correction of spinal deformity. Results After surgery low back pain was relieved immediately in all the patients. The average postoperative correction angle of kyphosis was 33 degrees. Two cases complicated with cerebrospinal fluid leak, but no deep infection or neurological complications occurred. After an average of 31-month follow-up, all the cases showed the bone fusion without internal fixation loosening. Conclusions This study suggests that thoracolumbar stress fractures in patients with ankylosing spondylitis are extremely unstable and require operations. A single posterior surgical procedure of 360-degree intervertebral fusion and fixation is easy and effective. Interbody TLIF cage placement combined with transvertebral osteotomy can achieve favorable correction of kyphosis.