Ankylosing Spondylitis Complicated with Traumatic Spinal Cord Injury: A Case Report

僵直性脊椎炎合併外傷性脊髓損傷：病例報告

黃光聖(Guang-Seng Huang) ； 陳信穎(Hsin-Ying Chen) ； 曹智超(Jyh-Chaur Tsau)

《中華民國復健醫學會雜誌》 18期 (1990/12) Pp. 192-196

摘要

僵直性脊椎炎在台灣並不少見，僵直性脊椎炎病人如外傷將比正常人更易引起脊椎骨折。依據統計，這類病人中約有四分之三合併脊髓損傷。此類骨折易發生的原因在於罹病的脊椎變得又硬又脆，稍受外力衝擊即易斷裂。又這類骨折四分之三發生於頸椎，此乃因頸椎失去原有的彈性及前突輻度，易導致遠端頸椎往後移位以及頸髓損傷。這類脊髓損傷由於常伴有許多僵直性脊椎炎的合併症，故可能使復健計劃變得更複雜。
本文報告一位六十歲男性僵直性脊椎炎病人。由於車禍引起第十、十一胸椎移位性骨折合併第十一胸髓截癱。由於骨質太脆，未予以內固定。在長達十六週的臥床期間，病人使用一個楔形海綿墊，支撐其彎曲的胸椎。臥床結束後，並給予一個配合其胸椎彎曲度的波士頓背架，使病人能坐起來。他的復健過程進行得十分緩慢，而且復健結果也較一般同樣程度的脊髓損傷患者差，因為他尚有周邊關節炎及嚴重限制性肺病，影響到輪椅操作及日常生活訓練。
基於本病例之經驗，僵直性關節炎的病人，即使僅有輕微外傷，亦須小心評估，以早期發現及預防可能發生的脊髓損傷。如已發生脊髓損傷，其復健計劃需要依病情之特殊性予以調整。

並列摘要

Ankylosing spondylitis (AS) is not a rare disease in Taiwan. People with AS are prone to develop spinal fracture following trauma. The spine may become stiff and fragile as the effect of the disease process. This kind of spinal fractures most frequently affect cervical spine and result in severe neurological deficits. If it is not rational to stabilize the fractured spine surgically, a long period of immobilization may ensue prior to rehabilitation training. In addition, other manifestations of AS may further complicate the rehabilitation program. This case report concerns the course and rehabilitation outcome of an AS patient complicated with traumatic thoracic spinal fracture and T11 paraplegia. We conclude that we should pay much attention to AS patient complicated with spinal cord injury even though trauma is only trivial. Thorough evaluation and proper rehabilitation program are emphasized.

並列關鍵字

Spinal cord injury ； Ankylosing spondylitis ； Rehabilitation