[1]谢国华,薛峰,杨建平,等.强直性脊柱炎脊柱应力性骨折的诊断[J].中医正骨,2012,24(12):72-74.
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强直性脊柱炎脊柱应力性骨折的诊断()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第24卷
期数:
2012年12期
页码:
72-74
栏目:
脊柱损伤
出版日期:
2012-12-20

文章信息/Info

作者:
谢国华; 薛峰; 杨建平; 牟晓峰; 陆根华
江苏省常州市中医医院,江苏 常州 213000
关键词:
脊柱炎; 强直性 脊柱骨折 诊断
摘要:
目的:探讨强直性脊柱炎脊柱应力性骨折的临床表现、血液检查结果及影像学特点,为该病的临床诊断提供参考。方法:2000年6月至2010年6月,治疗强直性脊柱炎脊柱应力性骨折患者11例,男8例,女3例; 年龄29～65岁,中位数48岁。骨折部位:T101例,T10、T113例,T11、T124例,T12、L12例,L1、L21例。对11例患者的病例资料进行回顾性分析,总结其临床表现、血液检查结果及影像表现的特点。结果:11例患者均有腰背部疼痛症状,均有不同程度的胸腰段脊柱后凸畸形。有脊髓损伤表现3例,骨折部位均有明显压痛,双下肢肌力均为4级,感觉减退,膝腱和跟腱反射减弱,Frankel分级为D级。血清人类白细胞抗原-B27均为阳性; 类风湿3项检查均为阴性; 血沉20～30 mm·h-13例,低于10 mm·h-18例。脊柱X线片均显示椎间盘及脊柱周围韧带有明显的骨化,椎体间已形成骨桥,椎体变方,呈典型的“竹节样”改变,且有骨质疏松表现,骨折椎体终板骨质破坏,形状不规则; 骶髂关节正位X线片显示关节间隙消失。CT重建片显示骨折均累及脊柱三柱,其中有明显脱位2例; 骨折线经过T10椎体1例,其余骨折线均位于椎间隙; 矢状位见骨折端相邻椎体的终板面或骨折断端有广泛的骨质破坏,边缘不整,周围骨质硬化,有假关节形成。MRI检查显示骨折节段有不规则的低信号影贯穿脊柱的前、中、后柱,T1加权像骨折节段均表现为低信号影,T2加权像低信号9例,高信号2例; 椎管内脊髓有受压表现3例,其中骨折端脱位2例,椎管内血肿压迫1例。结论:对于脊柱疼痛突然加重或后凸畸形急剧进展的强直性脊柱炎患者,无论是否有外伤史,都应高度怀疑脊柱骨折。强直性脊柱炎脊柱应力性骨折血液检查常见血清人类白细胞抗原-B27阳性,类风湿3项阴性; X线表现为脊柱呈典型的“竹节样”改变,骨折椎体终板骨质破坏,形状不规则; CT及 MRI重建可见骨折累及脊柱三柱。

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更新日期/Last Update: 2012-12-20