僵直性脊椎炎患者併第十 、十一胸椎骨析－病例報告

Fracture of The T10,T11 Vertebral Body in A Patient with Ankylosing Spondylitis-A Case Report

賴建宏(Chien-Hung Lai) ； 魏大森(Ta-Sen Wei)

《中華民國復健醫學會雜誌》 24卷2期 (1996/12) Pp. 159-165

摘要

47歲男性病人，由三輪車下來時不慎跌倒，併發劇烈背痛及雙下肢酸麻，送醫後發現為未經診斷之僵直性脊椎炎併第十、十一胸椎橫向骨折。患者接受臥床休息、干擾波、熱療、肌力強化運動及背部支架等保守性復健治療，患者出院時日常生活機能接近正常，雙下肢酸麻情形不復見，偶而併有背部疼痛，沒有明顯神經併發症。發病半年後之追蹤檢查，情況穩定。
本病例報告目的在提醒臨床醫師：
1.僵直性脊椎炎患者出現背痛或有小碰撞時，必須詳細病史詢問及臨床檢查，以期早期發現脊椎骨折或其他損傷，適當治療。
2.此類患者脊椎骨折之後即使沒有明顯神經缺陷也必須小心照護以免併發遲發性神經損傷。

關鍵字

僵立性脊椎炎 ； 脊椎骨折 ； 竹節脊椎 ； 骨質密度

並列摘要

A forty-seven-year-old male patient fell down from a tricycle. He suffered from severe back pain and bilateral lower leg soreness. Undiagnosed ankylosing Spondylitis with T10,T11 vertebral transverse fracture was impressed after examination. The patient received conservative rehabilitation program including complete bed rest, interferential current (IFC) therapy, local heat and strengthening exercise of trunk and limbs muscles. Knight-Taylor spinal orthosis was prescribed later for spinal stability. After 5 weeks therapy, he was discharged and followed regularly in the outpatient department. At present, daily activity of the patient is nearly normal and lower leg soreness is subsided . He does not suffer from significant neurological complication except mid-back pain occasionally .
This case report reminds us about the following concepts:
1. For early detection and adequate management of spinal fracture, the physician should pay much attention to history taking and clinical examination as back pain or trivial injury occurred in patient with A.S.
2. Even if there is no neurological deficit occurred following spinal fracture in patient with A.S., educate the patient to protect the spine and avoid trauma is crucial for prevention of neurological deficit of delayed onset.

並列關鍵字

ankylosing spondylitis ； spinal fracture ； bamboo spine ； bone mineral density