僵直性脊椎炎合併脊髓損傷病患復健預後之探討

Clinical Experience in Rehabilitation of Ankylosing Spondylitis Associated With Spinal Cord Injury

董莉貞(Li-Chen Tung) ； 何志香(Chih-Hsiang Ho) ； 畢柳鶯(Liu-Ing Bih)

《中華民國復健醫學會雜誌》 28卷3期 (2000/09) Pp. 145-151

摘要

Ankylosing spondylitis is an inflammatory disease of the axial skeleton. Spinal ankylosis reduces vertebral flexibility, exacerbates osteoporotic change, and leads to a loss of the biomechanical function of the spine. Thus, even small impacts might cause vertebral fracture or damage of the spinal cord in the patients with ankylosing spondylitis.
This retrospective study included 11 patients with ankylosing spondylitis who were admitted to a hos-pital between 1991 and 1999 for rehabilitative service after spinal cord injury. Of these patients, 10 were male, and one female. Average age was 46.3 ± 14.3 years. Falls accounted for injuries in six patients, traffic accidents in three, impact by a heavy object in one case, and one case showed no obvious cause. Fractured vertebrae were defined in ten of the eleven patients. Six patients had damage to the cervical cord, and five to the thoracic cord; five belonged to incomplete injury, and six were of complete type. Ten patients underwent surgery, and the remaining patient received a conservative course of treatment including a cervical collar and cervical traction. The Barthel ADL index was used to assess patients’ function. The average score was 21.4/100 on admission, and 57.7/100 before discharge. The Barthel ADL index scores showed significant improvement from admission to discharge with paired t tests analysis (p＜ 0.05). However, all patients suffered somewhat limitations in their daily activities and mobility upon discharge, which was due to the pre-existing spinal stiffness and reduced ROM in other joints when compared to those with similar cord damage but normal vertebrae. Spinal cord injury in the context of ankylosing spondylitis yields less optimal results, increases the challenge and reduces the effectiveness of rehabilitation.
In conclusion, the prognosis of rehabilitation for patients with ankylosing spondylitis and spinal cord injury is not solely determined by the extent of cord injury. Limited range of motion of other joints, stiffness of spine, and the presence of osteoporosis all influence its outcome. However, the intensive rehabilitation program still benefits the patient.

關鍵字

僵直性脊椎炎 ； 脊髓損傷 ； 巴特爾指數

並列摘要

Ankylosing spondylitis is an inflammatory disease of the axial skeleton. Spinal ankylosis reduces vertebral flexibility, exacerbates osteoporotic change, and leads to a loss of the biomechanical function of the spine. Thus, even small impacts might cause vertebral fracture or damage of the spinal cord in the patients with ankylosing spondylitis.
This retrospective study included 11 patients with ankylosing spondylitis who were admitted to a hos-pital between 1991 and 1999 for rehabilitative service after spinal cord injury. Of these patients, 10 were male, and one female. Average age was 46.3 ± 14.3 years. Falls accounted for injuries in six patients, traffic accidents in three, impact by a heavy object in one case, and one case showed no obvious cause. Fractured vertebrae were defined in ten of the eleven patients. Six patients had damage to the cervical cord, and five to the thoracic cord; five belonged to incomplete injury, and six were of complete type. Ten patients underwent surgery, and the remaining patient received a conservative course of treatment including a cervical collar and cervical traction. The Barthel ADL index was used to assess patients’ function. The average score was 21.4/100 on admission, and 57.7/100 before discharge. The Barthel ADL index scores showed significant improvement from admission to discharge with paired t tests analysis (p＜ 0.05). However, all patients suffered somewhat limitations in their daily activities and mobility upon discharge, which was due to the pre-existing spinal stiffness and reduced ROM in other joints when compared to those with similar cord damage but normal vertebrae. Spinal cord injury in the context of ankylosing spondylitis yields less optimal results, increases the challenge and reduces the effectiveness of rehabilitation.
In conclusion, the prognosis of rehabilitation for patients with ankylosing spondylitis and spinal cord injury is not solely determined by the extent of cord injury. Limited range of motion of other joints, stiffness of spine, and the presence of osteoporosis all influence its outcome. However, the intensive rehabilitation program still benefits the patient.

並列關鍵字

ankylosing spondylitis ； spinal cord injury ； Barthel ADL index