Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients
Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients
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DOI：
10.1016/j.spinee.2013.06.038
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发表时间：
2014-05-01
期刊：
影响因子：
4.5
通讯作者：
Verlaan, J. J.
中科院分区：
文献类型：
--
作者：
Westerveld, L. A.;van Bemmel, J. C.;Verlaan, J. J.
背景情况：与一般创伤人群相比，强直性脊柱疾病（ASD）患者脊柱骨折的临床结局更差。强直性脊柱炎（AS）和弥漫性特发性骨肥厚（DISH）患者脊髓损伤后神经功能缺损、并发症和死亡率与对照组患者的比较。回顾性队列研究。患者样本：所有年龄大于50岁的创伤性脊柱骨折患者，均在荷兰乌得勒支大学医学中心急诊科（一个地区一级创伤中心和三级脊柱转诊中心）住院。科摩罗数据（Charlson合并症评分）、创伤机制、骨折特征、神经功能缺损、并发症和住院死亡率。采用Logistic回归分析，研究ASD与死亡率之间的关系以及其他已知的死亡率危险因素。AS组14例（8.5%），DISH组40例（24.2%），对照组111例（67.3%）。强直性脊柱疾病患者比对照组患者大约大5岁，并且主要是男性。Charlson合并症评分在各组之间没有显著差异，但2型糖尿病和肥胖在DISH患者中更为普遍。在许多AS和DISH病例中，骨折是由低能量创伤引起的，并显示出过伸构型。与对照组（12.6%; p= 0.002）相比，AS和DISH患者经常因神经功能缺损而入院（分别为57.1%和30.0%），大多数病例没有改善。在AS和DISH患者中，并发症和死亡率明显高于对照组。Logistic回归分析表明，年龄和存在的DISH的参数是独立的，统计学显着相关的mortality.CONCLUSIONS：许多患者与AS和DISH表现出不稳定（过伸）骨折的配置和神经功能缺损。ASD患者的并发症和死亡率高于对照组患者。年龄增长和DISH的存在是脊柱骨折后死亡率的预测因素。(C)2014爱思唯尔公司All rights reserved.
BACKGROUND CONTEXT: The clinical outcome of patients with ankylosing spinal disorders (ASDs) sustaining a spinal fracture has been described to be worse compared with the general trauma population.PURPOSE: To investigate clinical outcome (neurologic deficits, complications, and mortality) after spinal injury in patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) compared with control patients.STUDY DESIGN: Retrospective cohort study.PATIENT SAMPLE: All patients older than 50 years and admitted with a traumatic spinal fracture to the Emergency Department of the University Medical Center Utrecht, the Netherlands, a regional level-1 trauma center and tertiary referral spine center.OUTCOME MEASURES: Data on comorbidity (Charlson comorbidity score), mechanism of trauma, fracture characteristics, neurologic deficit, complications, and in-hospital mortality were collected from medical records.METHODS: With logistic regression analysis, the association between the presence of an ASD and mortality was investigated in relation to other known risk factors for mortality.RESULTS: A total of 165 patients met the inclusion criteria; 14 patients were diagnosed with AS (8.5%), 40 patients had DISH (24.2%), and 111 patients were control patients (67.3%). Ankylosing spinal disorder patients were approximately five years older than control patients and predominantly of male gender. The Charlson comorbidity score did not significantly differ among the groups, but Type 2 diabetes mellitus and obesity were more prevalent among DISH patients. In many AS and DISH cases, fractures resulted from low-energy trauma and showed a hyperextension configuration. Patients with AS and DISH were frequently admitted with a neurologic deficit (57.1% and 30.0%, respectively) compared with controls (12.6%; p=.002), which did not improve in the majority of cases. In AS and DISH patients, complication and mortality rates were significantly higher than in controls. Logistic regression analysis showed the parameters age and presence of DISH to be independently, statistically significantly related to mortality.CONCLUSIONS: Many patients with AS and DISH showed unstable (hyperextension) fracture configurations and neurologic deficits. Complication and mortality rates were higher in patients with ASD compared with control patients. Increasing age and presence of DISH are predictors of mortality after a spinal fracture. (C) 2014 Elsevier Inc. All rights reserved.