Surgical Outcomes of Minimally Invasive Stabilization for Spinal Fractures in Patients with Ankylosing Spinal Disorders.
Surgical Outcomes of Minimally Invasive Stabilization for Spinal Fractures in Patients with Ankylosing Spinal Disorders.
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DOI：
10.4184/asj.2018.12.3.434
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发表时间：
2018-06
影响因子：
2.3
通讯作者：
Shidahara S
中科院分区：
文献类型：
--
作者：
Kai K;Ikuta K;Masuda K;Kitamura T;Senba H;Shidahara S
回顾性研究。评价经皮椎弓根螺钉微创稳定治疗强直性脊柱疾病（ASD）合并脊柱骨折的临床和影像学结果。asd，如强直性脊柱炎（as）和弥漫性特发性骨骼肥厚症（DISH），由于脊柱柔韧性极大降低，增加了脊柱骨折的易感性。此类骨折往往不稳定，因此应采用多节段内固定治疗。然而，传统的内固定手术会严重损伤软组织，导致严重出血。因此，MISt是治疗ASD患者脊柱骨折的首选方法。本研究回顾了2009年4月至2016年8月期间，9例ASD患者（4男5女；3例AS和6例DISH患者）脊柱骨折采用MISt联合PPSs治疗。1例患者在随访期间死于吸入性肺炎（FU），其余8例患者接受了临床和放射学评估。手术时平均年龄为79.6岁（68-95岁）。术后FU平均持续14.2个月（范围3-30个月）。所有治疗的骨折均为前后关节损伤伴牵张。3例患者在创伤后出现延迟性术前神经功能缺损。平均手术时间179.6 min（范围92 ~ 340 min）。平均出血103.6 mL（范围，无法量化至480 mL）。FU的放射学评估显示骨折椎体保留了可接受的术后矫正，因为FU期间没有骨折椎体再次塌陷。必须承认，ASD患者极易发生不稳定的脊柱骨折，即使在相对轻微的创伤后也是如此。使用pps的MISt可能是这类患者脊柱骨折的有效治疗方法。
A retrospective study. To evaluate the clinical and radiological outcomes of ankylosing spinal disorder (ASD) patients with spinal fractures treated by minimally invasive stabilization (MISt) using percutaneous pedicle screws (PPSs). ASDs, such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH), increase susceptibility to spinal fractures because of extremely decreased spinal flexibility. Such fractures tend to be unstable and, consequently, should be treated with multiple-segmental internal fixation. However, conventional internal fixation procedures can severely damage the soft tissue, resulting in severe hemorrhage. Therefore, MISt is the preferred approach to treat spinal fractures in ASD patients. Nine ASD patients (four males and five females; three AS and six DISH patients) with spinal fractures who were treated by MISt using PPSs, were reviewed from April 2009 to August 2016. One patient died of aspiration pneumonia during follow-up (FU), and the remaining eight patients underwent clinical and radiological evaluation. The mean age at surgery was 79.6 years (range, 68–95 years). The mean duration of postoperative FU was 14.2 months (range, 3–30 months). All treated fractures were anterior and posterior element injuries with distraction. Three patients presented delayed onset preoperative neurological deficit following trauma. The mean operation time was 179.6 minutes (range, 92–340 minutes). The mean hemorrhage was 103.6 mL (range, unquantifiable to 480 mL). Radiological evaluations at FU showed preservation of the acceptable postoperative correction of the fractured vertebra, as there were no re-collapses of the fractured vertebrae during FU. ASD patients must be acknowledged as highly susceptible to unstable spinal fractures, even after relatively mild trauma. MISt using PPSs may be an effective treatment for spinal fractures in such patients.