Comparative Study Of Different Surgical Approaches For Ankylosing Spondylitis With Cervical Spine Fractures

Purpose:By comparing the surgical data and the curative effect of different surgical approaches for ankylosing spondylitis with cervical fractures,to explore the choice of surgical approach for ankylosing spondylitis with cervical fractures.Methods:A total of 32 patients with ankylosing spondylitis combined with cervical fracture surgery who met the screening criteria and were completed in our hospital from June 2008 to September 2019 were collected,of which 15 patients underwent anterior surgery,9 patients underwent posterior surgery,and 8 patients underwent combined anterior and posterior surgery.Patients were divided into three groups by it.There were 5 cases with fracture segments above C₅ and 27 cases with C_5-7.There were 5 cases of fracture line through vertebral body,18 cases of through vertebral space,9 cases of through vertebral space and vertebral body,and 23 cases of dislocation.There were 4 cases of fracture combined with epidural hematoma.Analyze and compare the operation time,operative blood loss,and fracture healing time of the three groups of patients,changes in Cobb angle,VAS score,and ASIA grade before and after surgery.Result:All the patients successfully completed the operation and were followed up for6-24 months,with an average of 15.8 months.The average time of anterior operation was 118.35±15.19min,intraoperative hemorrhage was 145.29±16.45ml,and the average time of fracture healing was 3.70 months;the average time of posterior operation was 213.72±34.16min,intraoperative hemorrhage was 324.29±31.75ml,and the average time of fracture healing was 3.62 months;The time of anterior and posterior combined operation was 278.27±35.85min and the amount of bleeding was692.74±62.94ml,and the time of fracture healing was 3.59 months.Compared with the other two operations,the operation time of anterior approach is shorter,and the difference is statistically significant?P<0.05?;the amount of bleeding in operation is significantly reduced,and the difference is statistically significant?P<0.05?.The cervical vertebra sequence of the patients with fracture displacement could be restored to normal after the three kinds of operation,and the Cobb angle was significantly improved after the operation,the difference was statistically significant?P<0.05?.Postoperative pain was alleviated in all three surgical methods,and the improvement of pain in the anterior approach was more significant than that in the other two groups3 days after surgery,the difference was statistically significant?p<0.05?.At the6-month follow-up,there was no significant difference in pain between the three groups?P>0.05?.All three kinds of surgery can make fractures heal well,and there is no significant difference in healing time between groups?P>0.05?.The Asia rating of most patients was higher than that before operation,7 cases were B grade before operation,the follow-up was C or D grade 6 months after operation;12 cases were C grade,the follow-up was D or E grade 6 months after operation,4 cases were complete spinal cord injury before operation,and the neurological function was recovered 6 months after operation.One patient underwent anterior surgery with cerebrospinal fluid leakage,which improved a week after surgery;A case of bedsore was complicated due to the limitation of body position and improper turn over nursing;Pulmonary inflammation occurred in 2 patients who were treated with anterior and posterior combined operation after operation,which was relieved after anti infection treatment.Conclusion:1.For patients with ankylosing spondylitis and cervical spine fractures,single anterior,single posterior,and anterior and posterior approaches can make the fractures heal well,and they have improved significantly in pain relief,nerve function recovery,and cervical stability reconstruction.2.The single anterior surgery is a safe and reliable surgical method,which is superior to combined posterior and anterior and posterior approaches in terms of operation time,intraoperative blood loss,and early pain relief.The intensity of internal fixation of posterior and anterior posterior combined operation is better than that of single anterior operation,which has advantages in the treatment of fracture and dislocation of posterior lamina and facet.3.For the choice of the operative approach,the single anterior approach should be given priority,but the best operative method should also be selected in combination with the degree of the three columns of the cervical spine damaged,the position of the spinal cord compressions,the deformity of the cervical spine?flexion or hyperextension?,and the tolerance of the whole body to the operation.