上颈椎类风湿关节炎与脊髓损伤_谭俊铭VIP专享VIP免费

#临床研究#上颈椎类风湿关节炎与脊髓损伤谭俊铭,史建刚,严望军,许国华,贾连顺,李家顺【摘要】目的对颈椎类风湿关节炎累及枕颈部或寰枢椎的患者行颈后路植骨融合内固定治疗。方法对本组17例颈椎类风湿关节炎的患者(神经功能损害按Ranawat分级:Ⅱ级5例、ⅢA级10例、ⅢB级2例),行颈后路植骨融合内固定术,其中4例垂直半脱位(VS)患者和4例难复性寰枢椎半脱位(AAS)患者行枕颈减压融合内固定术、9例可复性或复位效果较好的AAS患者行钛缆寰枢椎融合固定术。结果随访1.5~7.5年(平均3.5年),17例均获骨性融合,15例患者的神经功能获不同程度改善,2例虽无改善但亦无神经损伤加重。结论早期寰枢椎或枕颈部稳定手术,似可有效减缓颈椎类风湿关节炎(RA)的炎症破坏过程;同时发现RA病程仍呈进行性,但术后17例患者的齿突周围血管翳较术前明显减小。【关键词】寰枢关节;类风湿关节炎;脊髓损伤;齿后血管翳【中图分类号】R651.21【文献标识码】A【文章编号】1672-2957(2005)05-0257-0260-04RheumatoidarthritisoftheuppercervicalspineandspinalcordinjuryTANJunming*,SHIJiangang,YANWangjun,etal.*DepartmentofOrthopaedics,the98thHospitalofPLA,Huzhou313000,China【Abstract】ObjectiveToinvestigatetheresultsofsurgicaltreatmentofoccipitocervicaloratlantoaxialsegmentinvolvedinrheumatoidarthritisthroughposteriorapproachfusionwithgraftandinternalfixation.MethodsTheseverityofneurologicaldamagewasclassifiedintothreegroupsaccordingtoRanawat:5patientsinGradeⅡ,10inGradeⅢAand2inGradeⅢB.Seventeenpatientsofoccipitocervicaloratlantoaxialregioninvolvedinrheumatoidarthritisweretreatedwithposteriorapproachfusionwithgraftandinternalfixation.Fourpatientswithverticalsubluxationandfourpatientswithirreducibleanterioratlanto-axialsubluxationweretreatedwithoccipitocervicalfusioncombinedwithlaminectomyoftheatlasordecompressionofthefora-menmagnum,and9patientsweretreatedwithatlantoaxialfusionwithtitaniumwiringastheanterioratlantoaxialsubluxationcouldbereduced.ResultsWithmeanfollow-upperiodof3.5years(range1.5-7.5years),satisfactorystabilizationoftheatlantoaxialoroccipitocervicalsegmentwasachievedinall17patientswithoutanycomplication,andradiographicassessmentsdemonstratedcompleteosseousunion.Neurologicalimprovementwasobservedin15patientsafteroperation,exceptthat2pa-tientsremainedtheiroriginalneurologicdeficit.ConclusionEarlystabilizationofatlantoaxialoroccipitocervicalsegmentmaybeabletoeffectivelydecreasetheriskoftheinflammatoryprocesswithdestructionandprogressionofcervicalinstability,andtheirperiodontoidpannuseshadbeenobviouslydiminishedduringfollow-upexaminationinspiteoftheongoingcourseofthedisease.【Keywords】atlanto-axialjoint;rheumatoidarthritis;spinalcordinjuries;retrodentalpannusJSpinalSurg,2005,3(5):257-260颈椎类风湿关节炎(Rheumatoidarthritis,RA)又称类风湿性颈椎炎,而寰枢椎不稳是颈椎RA患者的最常见影像学征象,文献示这些患者大部分预期无严重的神经性损伤。我们于1998年1月~2004年1月期间手术治疗且获得随访的17例上颈椎RA患者,RA的诊断均符合ACR(AmericanCol-作者简介:谭俊铭(1969-),博士在读,主治医师作者单位:313000浙江,解放军第98医院骨科(谭俊铭);第二军医大学附属长征医院骨科(史建刚,严望军,许国华,贾连顺,李家顺)legeofRheumatology)的标准[1],临床效果满意。1资料与方法1.1临床资料本组男4例、女13例,年龄35~76岁,平均56.4岁,病程均\5年。临床表现:主诉颈痛15例,枕颈部症状10例,脊髓型颈椎病12例(其中腱反射亢进10例)。1.2影像学检测标准①寰齿前间距(AADI):为寰椎前弓后缘与齿#257#脊柱外科杂志,2005年10月,第3卷第5期JSpinalSurg,October2005,Vol3,No5突前缘之间的骨间距离,如成人伸/屈侧位片的AA-DI相差>3mm则提示寰枢椎半脱位(atlantoaxialsubluxati...