【摘要】 目的 探讨强直性脊柱炎(AS)伴发脊柱骨折的损伤机制及影像学特点,减少漏诊、误诊。方法 回顾15例AS伴脊柱骨折患者的影像和临床资料,及37例普通脊柱骨折患者的资料,并对其进行分析。结果 在AS患者中,有明确外伤史的11例,影像学上表现为三柱骨折的9例,可见明确椎管受压或脊髓损伤的7例,骨折经过椎间部位的6例;在普通脊柱骨折患者中,有明确外伤史的36例,影像学上表现为三柱骨折的4例,可见明确椎管受压或脊髓损伤的5例,无骨折经过椎间部位。统计分析发现:AS伴脊柱骨折患者与普通脊柱骨折患者相比,无外伤原因所占比率差异有统计学意义(χ~2=4.565,P<0.05),患者发生三柱骨折的比率差异有统计学意义(χ~2=11.274,P<0.05),骨折导致椎管受压或脊髓损伤的比率差异有统计学意义(χ~2=4.873,P<0.05),骨折经过椎间部位发生的比率差异有统计学意义(χ~2=13.041,P<0.05)。结论 AS伴发脊柱骨折与普通脊柱骨折损伤机制有明显的差异,X线、CT和MRI在显示AS伴脊柱骨折方面各有优势,有效地运用这些差异以及选用合适的影像检查将有助于减少漏、误诊。更多还原

【Abstract】 Objective To explore injury mechanism and imaging manifestations of ankylosing spondylitis(AS) with spinal fracture so as to reduce missed diagnosis and misdiagnosis.Methods Imaging and clinical data of 15 patients with AS in combination with spinal fracture as well as 37 patients with common spinal fracture were reviewed retrospectively and analyzed subsequently.Results Among the patients with AS,11 had explicit trauma history,9 had three column fracture on images,7 had spinal canal compression or spinal cord injury,and 6 had fracture lines across the intervertebral disk.Among the patients with common spinal fracture,the corresponding number were 36,4,5 and 0 in sequence.There were significant differences between AS fracture group and common fracture group in trauma history(χ~2=4.565,P<0.05),three column fracture(χ~2=11.274,P<0.05),spinal canal compression or spinal cord injury(χ~2=4.873,P<0.05) and fracture across the intervertebral disk(χ~2=13.041,P<0.05).Conclusion There are obvious differences between AS with spinal fracture and common spinal fracture in injury mechanism.X-ray,CT and MRI have different advantages in the diagnosis of AS with spinal fracture,and choosing appropriate imaging techniques may reduce missed diagnosis and misdiagnosis.更多还原