[1]丁佳佳,张清,李晋杰,等.弥漫性特发性骨肥厚症合并胸腰椎骨折14例[J].中国中医骨伤科杂志,2024,32(05):72-78.[doi:10.20085/j.cnki.issn1005-0205.240514]
　DING Jiajia,ZHANG Qing,LI Jinjie,et al.Clinical Report of 14 Cases for Diffuse Idiopathic Skeletal Hyperostosis Combined with Thoracolumbar Fractures[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(05):72-78.[doi:10.20085/j.cnki.issn1005-0205.240514]
点击复制

弥漫性特发性骨肥厚症合并胸腰椎骨折14例()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年05期
页码:
72-78
栏目:
临床报道
出版日期:
2024-05-15

文章信息/Info

Title:
Clinical Report of 14 Cases for Diffuse Idiopathic Skeletal Hyperostosis Combined with Thoracolumbar Fractures
文章编号:
1005-0205(2024)05-0072-07
作者:
丁佳佳1; 张清2; 李晋杰2; 付庭帅1; 王沛然1; 陈华2△
1湖北中医药大学针灸骨伤学院(武汉,430061)
2湖北中医药大学附属湖北省中医院
Author(s):
DING Jiajia1; ZHANG Qing2; LI Jinjie2; FU Tingshuai1; WANG Peiran1; CHEN Hua2△
1College of Acupuncture and Orthopedics,Hubei University of Chinese Medicine,Wuhan 430061,China; 2Hubei Provincial Hospital of Traditional Chinese Medicine,Affiliated to Hubei University of Chinese Medicine,Wuhan 430061,China.
关键词:
弥漫性特发性骨肥厚症;  胸腰椎骨折;  强直性脊柱炎;  椎弓根钉;  内固定
Keywords:
diffuse idiopathic skeletal hyperostosis;  thoracolumbar vertebral fractures;  ankylosing spondylitis;  pedicle screws;  internal fixation
分类号:
R683.2
DOI:
10.20085/j.cnki.issn1005-0205.240514
文献标志码:
B
摘要:
目的:分析弥漫性特发性骨肥厚症(DISH)合并胸腰椎骨折的病例特点。方法:回顾性分析2018年1月至2022年10月诊治的14例弥漫性特发性骨肥厚症合并胸腰椎骨折病例资料,根据X线片、CT和MRI评估脊柱损伤类型:前柱经椎间盘损伤型骨折5例,经骨损伤型骨折3例,混合型骨折3例,不稳定型骨折3例。患者均行后入路胸腰椎骨折切开复位椎弓根螺钉内固定手术治疗。比较患者手术时间、术中出血量,术前及术后3个月、末次随访时疼痛视觉模拟量表(VAS)评分、Oswestry 功能障碍指数(ODI)、日本骨科学会(JOA)评分及美国脊柱损伤协会(ASIA)脊髓损伤分级评价其疗效。结果:患者的手术时间、术中出血量差异均无统计学意义(P>0.05)。患者在术后3个月与术前相比、末次随访时与术后3个月相比,腰痛VAS评分、腿痛VAS评分、ODI评分均明显降低,差异有统计学意义(P<0.05); JOA评分明显升高,差异有统计学意义(P<0.05)。患者的ASIA 分级为术前 C 级 1 例,D 级 13例; 末次随访时D 级3例,E 级 11 例; 神经功能较术前改善明显。结论:弥漫性特发性骨肥厚症患者因其疾病特点更容易出现脊柱骨折,临床医生要将其与其他疾病进行鉴别并合理诊治,避免出现误诊漏诊。
Abstract:
Objective:To analyze the characteristics of cases with diffuse idiopathic skeletal hyperostosis(DISH)combined with thoracolumbar vertebral fractures.Methods:A retrospective analysis was conducted on 14 cases of DISH combined with thoracolumbar vertebral fractures treated from January 2018 to October 2022.The spinal injury types were evaluated based on X-rays,CT,and MRI with anterior column through intervertebral disc injury fractures in 5 cases,through bone injury fractures in 3 cases,mixed fractures in 3 cases,and unstable fractures in 3 cases.All patients underwent posterior approach thoracolumbar vertebral fracture open reduction and internal fixation with pedicle screw surgery.Comparison of surgical time,intraoperative blood loss,preoperative,postoperative 3 months,and last follow-up visual analogue scale(VAS)for pain,Oswestry disability index(ODI),Japanese orthopedic association(JOA)scores,and American spinal injury association(ASIA)spinal cord injury grading were used to evaluate the efficacy.Results:There were no significant differences in surgical time,intraoperative blood loss among patients(P>0.05).Compared with preoperative values,at postoperative 3 months and last follow-up,lumbar pain VAS scores,leg pain VAS scores,and ODI significantly decreased,showing statistical significance(P<0.05).JOA scores significantly increased at postoperative 3 months and last follow-up,demonstrating statistical significance(P<0.05).ASIA grades of patients were 1 case of grade C and 13 cases of grade D preoperatively.At the last follow-up,3 cases were grade D and 11 cases were grade E,indicating significant improvement in neurological function compared to preoperative status.Conclusion:Due to the characteristic features of DISH,patients are more prone to vertebral fractures.Clinicians should differentiate it from other diseases and provide rational diagnosis and treatment to avoid misdiagnosis and missed diagnosis.

参考文献/References:

[1] 戚力升,曹波,王清.弥漫性特发性骨肥厚症发病机制的研究进展[J].国际老年医学杂志,2016,37(1):45-48.
[2] MADER R,VERLAAN J J,BUSKILA D.Diffuse idiopathic skeletal hyperostosis:clinical features and pathogenic mechanisms[J].Nature Reviews Rheumatology,2013,9(12):741-750.
[3] KUMAR R R,JHA S,DHIR V,et al.Diffuse idiopathic skeletal hyperostosis with peripheral joint involvement[J].Journal of Clinical Rheumatology:Practical Reports on Rheumatic & Musculoskeletal Diseases,2020,26(7):e238-e239.
[4] RIQUIER D,BASCH A,JACQUIN-COURTOIS S,et al.L5-S1 Charcot spine induced by diffuse idiopathic skeletal hyperostosis in chronic tetraplegia:2 cases[J].Annals of Physical And Rehabilitation Medicine,2019,62(2):132-134.
[5] MADER R,VERLAAN J J,ESHED I,et al.Diffuse idiopathic skeletal hyperostosis(DISH):where we are now and where to go next[J].RMD Open,2017,3(1):e000472.
[6] GREATTING H H,YOUNG B D,POOL R R,et al.Diffuse idiopathic skeletal hyperostosis(DISH)[J].Veterinary Radiology & Ultrasound,2011,52(4):472-473.
[7] PASSIU G,SEBASTIANI G D,TUVERI M A.Diffuse idiopathic skeletal hyperostosis of the cervical spine in a patient with ankylosing spondylitis:description of a personal case[J].Annali Italiani Di Medicina Interna,1991,6(1 Pt 1):61-64.
[8] MADER R,BARALIAKOS X,ESHED I,et al.Imaging of diffuse idiopathic skeletal hyperostosis(DISH)[J].RMD Open,2020,6(1):e001151.
[9] ROTÉS-QUEROL J.Clinical manifestations of diffuse idiopathic skeletal hyperostosis(DISH)[J].British Journal of Rheumatology,1996,35(12):1193-1194.
[10] TANIGUCHI T,MAEJIMA H,WATARAI A,et al.A case of psoriasis vulgaris with diffuse idiopathic skeletal hyperostosis involved with ossifications of posterior and anterior longitudinal ligament[J].Rheumatology International,2012,32(5):1343-1345.
[11] BECH R D,ZIELINSKI O,MORGEN S S,et al.Spinefractures-diagnosis and treatment[J].Ugeskrift for laeger,2021,183(27):V08200628.
[12] YOSHIHARA H,VANDERHEIDEN T F,STAHEL P F.A missed injury leading to delayed diagnosis and postoperative infection of an unstable thoracic spine fracture-case report of a potentially preventable complication[J].Patient Safety in Surgery,2011,5:25.
[13] OKADA E,TSUJI T,SHIMIZU K,et al.CT-based morphological analysis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis[J].Journal of Orthopaedic Science,2017,22(1):3-9.
[14] REDJATI R,DAMADE R,ROYANT V.Spinal fracture in diffuse idiopathic skeletal hyperostosis[J].Joint Bone Spine,2018,85(4):489.
[15] OKADA E,SHIMIZU K,KATO M,et al.Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis:clinical characteristics by fracture level[J].Journal of Orthopaedic Science,2019,24(3):393-399.
[16] TALJANOVIC M S,HUNTER T B,WISNESKI R J,et al.Imaging characteristics of diffuse idiopathic skeletal hyperostosis with an emphasis on acute spinal fractures:review[J].American Journal of Roentgenology,2009,193(3 Suppl):S10-9.
[17] WENSLEY K E,ROLTON D.Posterior percutaneous screw fixation to treat vertebral fracture non-union in diffuse idiopathic skeletal hyperostosis[J].Cureus,2021,13(11):e19895.
[18] HISHIYA T,ISHIKAWA T,OTA M.Posterior spinal fixation using penetrating endplate screws in patients with diffuse idiopathic skeletal hyperostosis-related thoracolumbar fractures[J].Journal of Neurosurgery Spine,2021,34(6):936-941.
[19] KANEMATSU R,HANAKITA J,TAKAHASHI T,et al.Thoracic hyperextension injury with opening wedge distraction fracture in DISH-consideration of surgical strategy based on intraoperative pathological findings[J].Journal of Clinical Neuroscience,2020,75:231-234.
[20] OKADA E,SHIONO Y,NISHIDA M,et al.Spinal fractures in diffuse idiopathic skeletal hyperostosis:advantages of percutaneous pedicle screw fixation[J].Journal of Orthopaedic Surgery(Hong Kong),2019,27(2):2309499019843407.
[21] UMEGAKI M,FUKUNAGA T,NINOMIYA K,et al.Diffuse idiopathic skeletal hyperostosis with severely displaced spine fracture managed with posterior approach alone:case reports and literature review[J].NMC Case Report Journal,2022,9:401-405.
[22] KOBAYASHI K,OKADA E,YOSHII T,et al.Risk factors for delayed diagnosis of spinal fracture associated with diffuse idiopathic skeletal hyperostosis:a nationwide multiinstitution survey[J].Journal of Orthopaedic Science,2021,26(6):968-973.
[23] YAHARA Y,YASUDA T,KAWAGUCHI Y,et al.Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis[J].BMC Musculoskeletal Disorders,2020,21(1):93.
[24] BIEBER A,MASALA I F,MADER R,et al.Differences between diffuse idiopathic skeletal hyperostosis and spondyloarthritis[J].Immunotherapy,2020,12(10):749-756.
[25] PARIENTE E,PINI S F,OLMOS J M,et al.Early stages of diffuse idiopathic skeletal hyperostosis(DISH)and chronic inflammation:the Camargo Cohort Study[J].Clinical Rheumatology,2023,42(7):1931-1942.

备注/Memo

备注/Memo:
△通信作者 E-mail:ch1222@126.com
更新日期/Last Update: 2024-05-15