摘要
目的:探讨强直性脊柱炎(ankylo singspondylitis,AS)患者胸腰椎应力骨折的临床及影像学特点。方法:8例AS患者发生胸腰椎应力骨折,男性5例,女性3例,年龄29～60岁,平均46.2岁。骨折部位:T9～T111例,T11～T123例,T12～L14例。对其临床表现和X线片、CT及MRI检查资料进行回顾性分析。结果:首发症状主要为腰背疼痛突然加重;主要症状为腰背部疼痛经过一段稳定期后突然加剧或为腰背部疼痛加重,呈持续性;查体均有骨折节段的压痛和叩击痛,6例伴胸腰椎后凸畸形;2例患者脊髓功能Frankel分级为D级。X线片示8例均为胸腰椎应力骨折,骨折线经椎间隙,有假关节形成;CT检查示5例椎板骨折、椎间盘-椎体骨溶解及反应性硬化,1例可见椎体的骨皮质连续性中断、椎体破坏及溶骨性腔隙,2例可见椎体骨皮质连续性中断、椎板边缘不整及真空现象;MRI检查均有假关节节段不规则的低信号带延及后柱结构,其中6例表现为T1加权像低信号、T2加权像高信号,2例表现为T1加权像低信号、T2加权像低信号。结论:根据AS患者胸腰椎应力骨折的临床及影像特点,可以早期做出明确诊断。
Objective：To explore the clinical and imaging characteristics of the thoracic and lumbar stress fracture complicating with ankylosing spondylitis （AS）.Method：There were 5 men and 3 women,wiith age ranging from 29 to 60 years（mean,46.2 years）.The involved sgment located from T9 to L1 （T9-Tll in 1 pa- tient,Tll-T12 in 3 patients,T12-L1 in 4 patents ） .Imaging charaeteristics（radiography,CT and MRI） and clin- ical features were analyzed.Result：The initial symptom was aggravation of back pain,with back pain unexpect- edly intensified after a stable phase ,or presented with continually severe back pain.All patients had signs of tenderness percussion pain in the involved segment.Six patients presented with round thoracolumbar kyphosis. Of these patients,2 had a neurologic deficit of Frankel grade D.Eight patients had fracture lines extended through the disc spaces with the formation of pesudoarthrosis.Of the eight patients,CT scan demonstrated lami- na fracture,discovertebral osteolysis with reactive sclerosis in 5 patients;discontinuance of cortical bone of vertebral body ,destructive lesion and lytic gap of vertebral body in 1 patient;discontinuance of cortical bone of vertebral body,irregular lamina edge and vacuum phenomenon in 2 patients.All patients had irregular low signal band in the segment of pseudoarthrosis,which extended into the posterior column on the MR images. The pseudoarthrosis had two patterns：low signal on Tl-weighted and high signal on T2-weighted images were observed in 6 patients,and low signal on both T1- and T2-weighted images were evidenced in 2 patients. Conclusion ：Early and definite diagnosis of thoracic and lumbar stress fracture in AS can be achieved by fol- lowing its clinical and imaging features.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2008年第10期747-751,共5页
Chinese Journal of Spine and Spinal Cord
关键词
强直性脊柱炎
脊柱骨折
临床特点
影像
Ankylosing spondylitis
Spinal fracture
Clinical feature
Imaging
