ObjectiveTo evaluate the effectivity and safety of posterior osteotomy for thoracolumbar stress fracture in ankylosing spondylitis (AS) through the gap of a pathological fracture.MethodsBetween April 2012 and August 2015, 8 patients with AS combined with thoracolumbar stress fracture were treated with posterior osteotomy through the gap of a pathological fracture to correct the kyphosis. There were 7 males and 1 female, with an average age of 51 years (range, 37-74 years). The history of AS was 1-40 years (mean, 21.7 years) and disease duration of stress fracture was 2-60 months (mean, 18.5 months). The segmental lesions included T8, 9 in 1 case, T10, 11 in 2 cases, T11 in 2 cases, T12, L1 in 1 case, L1, 2 in 1 case, and L2, 3 in 1 case. The nerve function before operation according to Frankel grading was grade D in 3 cases and grade E in 5 cases. The pre- and post-operative X-ray films, CT three-dimensional reconstruction, and MRI were collected to measure the global kyphosis (GK), local kyphosis (LK), angle of the fusion levels (AFL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Visual analogue scale (VAS) score was used to assess the back pain intensity.ResultsThe operation time was 210-320 minutes (mean, 267 minutes), and the intraoperative blood loss was 400-2 000 mL (mean, 963 mL). Cerebrospinal fluid leakage was found in 3 patients, and the wound healed by removal of drainage tube and suturing drainage outlet after 5-7 days of operation. The wounds of the rest patients healed by first intention. Lower extremity numbness occurred in 1 case and recovered after 1 month of postoperative administration of oral mecobalamin. All the patients were followed up 20-43 months (mean, 28.4 months). No internal fixator loosening, fracture, and other complications occurred. All the fractures healed with the healing time of 3-12 months (mean, 6.8 months). At 3 months after operation, 3 cases with spinal cord injury of preoperative Frankel grade D recovered to grade E. The GK, LK, AFL, PI, PT, SVA, and VAS scores at 1 week after operation and at last follow-up were significantly improved when compared with preoperative ones (P<0.05). Except for VAS score at last follow-up was significantly improved when compared with that at 1 week after operation (P<0.05), there was no significant difference in the other indexes between at 1 week after operation and at last follow-up (P>0.05).ConclusionPosterior osteotomy through the gap of a pathological fracture is a safe and effective surgical procedure for kyphosis correction and relief of back pain in AS patients combined with thoracolumbar stress fracture. Successful bony fusion and good clinical outcomes can also be achieved by this surgical procedure.
目的 观察强直性脊柱炎髋关节受累强直时行全髋关节置换术的临床疗效。 方法 对2003年1月-2008年1月45例(78髋)强直性脊柱炎患者行全髋关节置换术，其中38例(55髋)进行了平均4.5年（2~7年）的随访。 结果 38例患者术后髋关节功能均明显改善，Harris评分由术前（16.3±1.7）分提高到术后（83.4±4.6）分。髋关节屈曲畸形矫正，55个髋关节总活动度(屈伸、内收、外展、内旋、外旋等6个方向活动总和)由术前（38.7±7.6）°增加至术后（191.2±10.3）°。术后髋关节疼痛消失，膝关节痛、腰骶部疼痛明显改善，步态较术前改善，生活自理。 结论 短期随访全髋关节置换术治疗强直性脊柱炎髋关节受累强直安全、有效。
Objective To explore the MRI features of juvenile-onset ankylosing spondylitis (JoAS) for improving the level of diagnosis and therapy. Methods MRI findings of JoAS in 25 patients confirmed by clinical and laboratory results between October 2010 and September 2014 were retrospectively analyzed. Results There were a total of 67 locations of lesion in the 25 cases, including 19 in sacroiliac joint, 21 in hip joint, 6 in ischial tuberosity, 6 in crista iliaca, 9 in knee joint, 4 in ankle joint, and 2 in foot. MRI showed 63 locations with bone marrow edema, 36 with joint effusion, 26 with bone destruction, and 19 with enthesitis. Conclusions Bone marrow edema is the most common MRI manifestation of JoAS, and the main bone destruction is middle axis joint. MRI is sensitive but not specific to lesions, so differential diagnosis is needed and helpful.
Objective To investigate the effect of the morphological changes in the proximal femur on the prothesis selection in the total hip arthroplasty in the patients with ankylosing spondylitis. Methods The experimental group was composed of 13 patients (16 hips) with ankylosing spondylitis, which was treated with the total hip arthroplasty, and the control group was composed of 16 patients（19 hips）with non-ankylosing spondylitis，which was also treated with the total hip arthroplasty. In the two groups, the measurements of Singh index，canal flare index，morphological index of the cortex and cortical index were performed in the two groups. Results The results of the statistical analysis on Singh index，canal flare index, morphological index of the cortex and cortical index in the experimental group were 3.81±0.54, 2.63±0.41, 2.02±0.38 and 1.69±0.69, respectively, but 4.63±0.62, 3.03±0.27, 2.76±0.28 and 2.12±0.24, respectively in the control group. Therewas a significant difference in Singh index, canal flare index, and morphological index of the cortex between the two groups (Plt;0.05)，while there was no statistical difference in cortical index between the two groups (P＞0.05). The patientswith ankylosing spondylitis had more serious osteoporosis in their proximal femur. Conclusion Cemented femoral prosthesis should be used in the total hip replacement in patients with ankylosing spondylitis, and the revision total hip arthroplasty should be performed on patients with more serious osteoporosis.
【摘要】 目的 探讨强直性脊柱炎合并脊柱骨折脱位的临床特点及手术治疗效果。 方法 2009年10月-2010年6月，共收治6例强直性脊柱炎合并脊柱骨折脱位患者，其中男5例，女1例；年龄38～76岁，平均48.6岁。下颈椎骨折脱位3例，2例为颈5-6、1例颈6-7；胸腰段骨折脱位3例，为胸10-11、胸11-12、胸12-腰1各1例。6例患者中除1例术前神经功能为Frankel分级 E级，其余5例均有不同程度的神经损伤。6例患者均行手术治疗，下颈椎骨折脱位采用前后联合入路复位及固定，胸腰段骨折脱位采用后路切开复位及椎弓根螺钉固定。术后观察手术节段内固定位置及骨融合情况，评估神经功能恢复情况，记录手术并发症。患者随访10~18个月，平均14.2个月。 结果 所有患者术后均未出现切口感染；脑脊液漏1例，换药对症处理3周后愈合。1例颈5-6骨折脱位患者行前路手术后第2天出现内固定移位，骨折椎再次脱位立即二次行前后联合入路复位固定术；3例术后神经功能由术前Frankel C级恢复至D级，2例无明显改善（术前均为A级），1例较术前加重（术前E级，术后为A级，经再次手术减压并康复治疗6个月后恢复至D级）。随访期间均达骨性融合，未出现内固定松动断裂移位现象。 结论 强直性脊柱炎脊柱骨折好发于下颈椎及胸腰段；对于下颈椎骨折脱位宜行前后联合入路复位固定，而胸腰段骨折宜行后路长节段椎弓根螺钉固定，术中应先充分减压后再精细复位，避免加重神经损伤。【Abstract】 Objective To explore the clinical characteristics of spinal fracture and dislocation in ankylosing spondylitis (AS) and its surgical treatment effect. Methods From October 2009 to June 2010, six cases with spinal fractures in AS underwent surgical treatment. There were 5 males and 1 female with an average age of 48.6 years (38-76 years old). The preoperative neural function of one case was grade E according to the Frankel classification and different degrees of neural damage could be found in other 5 cases. Three cases of lower cervical fractures underwent the operation with a combined posterior-anterior approach. Three cases of thoracolumbar fracture underwent the operation with posterior approach (posterior reduction, fixation with pedicle screws and bone graft). The situation of internal fixation and bone fusion was observed after operation, the neural function had been evaluated and the postoperative complications was recorded. Results All of the six patients were followed up for 10-18 months (mean 14.2 months). There was no incision infection. One patient with cerebrospinal fluid leakage was cured with conservative treatment for three weeks. One patient with C5-6 fracture and dislocation got anterior implant loosening and fracture-dislocation recurrence in the second day after the operation and underwent a combined posterior-anterior operation immediately. Three cases got remarkable neuronal function improvement after the operation. Two cases were remain primary situation. One case was aggravated from preoperative grade E grade to postoperative grade A and recovered to grade D after recovery treatment for 6 months. Bone fusion was achieved in all cases. There were no loosening and breakage of internal fixation in the later followed up. Conclusions Lower cervical and thoracolumbar spine are the usual locations of fracture in AS. A combined posterior-anterior surgical approach is effective for lower cervical fractures and posterior long-segmental reduction and the fixation is a desired select for thoracolumbar fractures.
ObjectiveTo systematically review the diagnostic value of HLA-B27 for ankylosing spondylitis (AS) in China. MethodsWe searched PubMed, The Cochrane Library (Issue 4, 2015), EMbase, CNKI, CBM, VIP and WanFang data from inception to April 2015, to collect diagnostic studies about HLA-B27 for AS in China. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then meta-analysis was performed using Meta-Disc 1.4 software. Pooled sensitivity (Sen), specificity (Spe), positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR), and area under the curve (AUC) of summary receiver operating characteristic curve (SROC) were calculated to assess the diagnostic value of individual diagnostic tests. Subgroup analysis was stratified by detection methods of HLA-B27. ResultsA total of 18 studies involving 22 comparisons, with 3 670 AS patients and 28 389 health controls were finally included. The results of meta-analysis showed that the pooled Sen, Spe, +LR,-LR, and DOR were 0.92 (95%CI 0.90 to 0.93), 0.94 (95%CI 0.94 to 0.95), 16.22 (95%CI 13.63 to 19.29), 0.08 (95%CI 0.06 to 0.10), and 256.49 (95%CI 168.25 to 391.00), respectively. The AUC of SROC was 0.98. The result of subgroup analysis showed that there was no significant difference for flow cytometry (FCM) and Polymerase Chain Reaction with Sequence-Specific Primer (PCR-SSP) in HLA-B27 detection for AS (Z=7.915, P=0.960). ConclusionCurrent evidence indicates that HLA-B27 detection is of great diagnostic value for AS. At present, FCM and PCR-SSP shows no significant difference in HLA-B27 detection for AS. Due to the limitation of the quality of included studies, and the exclusion of the suspected patients, higher quality studies are needed to verify the above conclusion.
Objective To evaluate the efficacy and toxicity of methotrexate (MTX) in the treatment of ankylosing spondylitis (AS). Methods Randomized controlled trials (RCTs) were identified from CENTRAL (The Cochrane Library Issue 4, 2005); MEDLINE (1966 to November 2005); EMBASE (1980 to November 2005); CINAHL (1982 to November 2005). The quality of included trials was evaluated. Data were extracted by two reviewers independently using a specially designed extraction form. The Cochrane Collaboration’s RevMan 4.2 software was used for data analysis. Results Three trials involving 116 patients were included. One 12-month trial compared naproxen plus MTX with naproxen alone. Two 24-week trials compared different doses of MTX with placebo. No statistically significant differences were found for the primary outcome measures of physical function, pain, spinal mobility, peripheral joints/entheses pain, swelling and tenderness, changes in spine radiographs and patient and physician global assessment. The response rate in one trial showed statistically significant benefits of 36% in the MTX group compared with the placebo group (RR 3.18, 95% CI 1.03 to 9.79). This response rate was a composite index including assessment of morning stiffness, physical well-being, Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), health assessment questionnaire for spondyloarthropathies (HAQ-S), and physician and patient global assessment. However, no single outcome showed a statistically significant difference between the MTX and placebo groups when endpoint results were compared. Therefore, this benefit of MTX was questionable. No serious side effects were reported in these studies. Conclusions There is no enough evidence to show any benefit of MTX in the treatment of AS. High quality randomized controlled trials of longer duration and with larger sample size are needed to clarify the effect of MTX on AS.
ObjectiveTo introduce a self-designed adjustable operation frame and explore the feasibility and safety in the treatment of severe kyphosis secondary to ankylosing spondylitis with posterior osteotomy.MethodsBetween March 2016 and May 2018, 7 cases of severe kyphosis secondary to ankylosing spondylitis were treated with posterior osteotomy using self-designed adjustable operation frame with prone position. There were 5 males and 2 females with an average age of 49.4 years (range, 40-55 years). The disease duration was 10-21 years (mean, 16.7 years). The apical vertebrae of kyphosis were located at T11 in 2 cases, T12 in 1 case, L1 in 1 case, and L2 in 3 cases. Among the 7 cases, 2 were classified as typeⅠ, 4 as type ⅡB, and 1 as type ⅢA according to 301 classification system. There was no neurological deficit of all cases; but 1 case suffered bilateral hip joints ankylosed in non-functional position. The parameters of chin-brow vertical angle (CBVA), global kyphosis (GK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sagittal vertical axis (SVA) were measured; and the operation time, the intraoperative blood loss, and the complications were also collected and analyzed.ResultsAll operations completed successfully. The operation time was 310-545 minutes (mean, 409.7 minutes) and the intraoperative blood loss was 1 500-2 500 mL (mean, 1 642.9 mL). There were 2 cases treated with one-level osteotomy of sagittal translation, 1 case of radiculopathy symptom of L3, and 3 cases of tension of abdominal skin. All patients were followed up 20-35 months (mean, 27.9 months). There were significant differences in CBVA, GK, TLK, LL, and SVA between pre- and post-operation (P<0.05); but no significant difference between 1 week after operation and last follow-up (P>0.05). All the osteotomies and bone grafts fused well and no complications of loosening and breakage of internal fixator occurred during the follow-up.ConclusionIn the posterior osteotomy for correction of severe kyphosis secondary to ankylosing spondylitis, the self-designed adjustable operation frame is convenient for the patient to be placed in prone position. It is safe, feasible, and effective to perform osteotomy correction with the aid of the self-designed adjustable operation frame.