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Abstract：
Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease that mainly affects the spine and involves the sacroiliac and peripheral joints. Low-energy trauma can often lead to spinal fractures and spinal cord injuries (SCIs), the treatment of AS is challenging. The prognosis of neurological function in patients with AS cervical fracture and SCI is a major problem that must sought clinician attention on urgent basis. A total of 106 patients with AS cervical fractures who underwent surgical treatment at Shanghai Changzheng Hospital between August 2009 and 2021 were included in this study. All the patients were divided into 2 groups (improved group and the control group) based on their neurological function improvement at 1 year mark after the surgery. The baseline characteristics, perioperative factors, and procedural outcomes of all the patients including injury type, AS drug treatment, the injured segment, ossified anterior longitudinal ligament injury, spinal hypersignal, decompression time window, operation duration, blood loss, preoperative and postoperative American Spinal Injury Association (ASIA) score were recorded and analyzed. Among the 106 patients, 79 demonstrated improved neurological function at 1 year mark after the surgery. Binary univariate logistic regression analysis revealed significant differences in injury type (P = .018), ossified anterior longitudinal ligament injury (P = .01), operation duration (P = .002), spinal hypersignal (P = .001), preoperative ASIA score (P < .001), and prior AS drug treatment (P = .012). No significant differences were observed in the other variables (P > .05). Binary multivariate logistic regression analysis identified spinal hypersignal (OR = 37.185, P = .028), preoperative ASIA score (OR = 0.16, P = .012) and previous AS drug treatment (OR = 0.296, P = .049) as factors associated with postoperative neurological function improvement. The preoperative ASIA score and previous drug treatment of AS were identified as protective factors affecting the improvement of neurological functions in patients with AS cervical fracture after surgery. Preoperative T2-weighted spinal hypersignal was identified as an independent risk factor affecting the improvement of neurological function recovery in patients with AS cervical fracture after the surgery.
摘要：
强直性脊柱炎（AS）是一种慢性进行性炎症性疾病，主要影响脊柱并累及骶髂关节和外周关节。低能量创伤通常会导致脊柱骨折和脊髓损伤（SCI）。AS的治疗具有挑战性。AS颈椎骨折合并SCI患者的神经功能预后是临床迫切需要关注的重大问题。纳入2009年8月至2021年在上海长征医院接受手术治疗的106例AS颈椎骨折患者。根据术后1年神经功能改善情况分为2组(改良组和对照组)。基线特征，围手术期因素，以及所有患者的手术结果，包括损伤类型，AS药物治疗，受伤的部分，前纵韧带骨化损伤，脊髓超信号,减压时间窗,操作持续时间,失血,术前、术后美国脊柱损伤协会(ASIA)评分进行记录和分析。在106名患者中，79在手术后1年表现出神经功能改善。二元单变量logistic回归分析显示损伤类型存在显着差异（P=0.018），前纵韧带骨化损伤（P=0.01），操作持续时间（P=.002），脊髓高信号（P=.001），术前ASIA评分（P<.001），和先前的AS药物治疗（P=0.012）。其他变量无显著差异(P>.05)。二元多变量logistic回归分析确定了脊髓高信号（OR=37.185，P=.028），术前ASIA评分（OR=0.16，P=.012）和既往AS药物治疗（OR=0.296，P=.049）是术后神经功能改善的相关因素。术前ASIA评分及既往AS药物治疗为影响AS颈椎骨折患者术后神经功能改善的保护因素。术前T2加权脊髓高信号是影响AS颈椎骨折患者术后神经功能恢复改善的独立危险因素。
