PDF(Pubmed)
Abstract：
Injuries to the rigid spine have a distinguished position in the broad spectrum of spinal injuries due to altered biomechanical properties. The rigid spine is more prone to fractures. Two ossification bone disorders that are of particular interest are Ankylosing Spondylitis (AS) and Diffuse Idiopathic Skeletal Hyperostosis (DISH). DISH is a non-inflammatory condition that leads to an anterolateral ossification of the spine. AS on the other hand is a chronic inflammatory disease that leads to cortical bone erosions and spinal ossifications. Both diseases gradually induce stiffening of the spine. The prevalence of DISH is age-related and is therefore higher in the older population. Although the prevalence of AS is not age-related the occurrence of spinal ossification is higher with increasing age. This association with age and the aging demographics in industrialized nations illustrate the need for medical professionals to be adequately informed and prepared. The aim of this narrating review is to give an overview on the diagnostic and therapeutic measures of the ankylosed spine. Because of highly unstable fracture configurations, injuries to the rigid spine are highly susceptible to neurological deficits. Diagnosing a fracture of the ankylosed spine on plain radiographs can be challenging. Moreover, since 8% of patients with ankylosing spine disorders (ASD) have multiple non-contagious fractures, a CT scan of the entire spine is highly recommended as the primary diagnostic tool. There are no consensus-based guidelines for the treatment of spinal fractures in ASD. The presence of neurological deficit or unstable fractures are absolute indications for surgical intervention. If conservative therapy is chosen, patients should be monitored closely to ensure that secondary neurologic deterioration does not occur. For the fractures that have to be treated surgically, stabilization of at least three segments above and below the fracture zone is recommended. These fractures mostly are treated via the posterior approach. Patients with AS or DISH share a significant risk for complications after a traumatic spine injury. The most frequent complications for patients with thoracolumbar burst fractures are respiratory failure, pseudoarthrosis, pneumonia, and implant failure.
摘要：
由于生物力学特性的改变，刚性脊柱的损伤在广泛的脊柱损伤中占有重要地位。刚性脊柱更容易骨折。特别感兴趣的两种骨化性骨疾病是强直性脊柱炎（AS）和弥漫性特发性骨骼肥大（DISH）。DISH是一种导致脊柱前外侧骨化的非炎性病症。另一方面,AS是导致皮质骨侵蚀和脊髓骨化的慢性炎性疾病。两种疾病都逐渐引起脊柱的僵硬。DISH的患病率与年龄有关，因此在老年人群中较高。尽管AS的患病率与年龄无关，但随着年龄的增长，脊髓骨化的发生率更高。工业化国家与年龄和人口老龄化的这种联系表明，医疗专业人员需要充分了解和做好准备。这篇叙述综述的目的是概述强直脊柱的诊断和治疗措施。由于裂缝结构高度不稳定，僵硬的脊柱损伤极易受到神经功能缺损的影响。在平片上诊断强直脊柱骨折可能具有挑战性。此外，由于8％的强直性脊柱疾病（ASD）患者患有多发性非传染性骨折，强烈建议对整个脊柱进行CT扫描作为主要诊断工具.对于ASD的脊柱骨折治疗，尚无基于共识的指南。神经功能缺损或不稳定骨折的存在是手术干预的绝对指征。如果选择保守治疗,应密切监测患者,以确保不会发生继发性神经系统恶化.对于必须手术治疗的骨折，建议在断裂带上方和下方至少稳定三段。这些骨折大多通过后路治疗。患有AS或DISH的患者在创伤性脊柱损伤后有明显的并发症风险。胸腰椎爆裂骨折患者最常见的并发症是呼吸衰竭，假关节炎,肺炎,和植入物失败。
