Keegan型颈椎病的临床诊断学特征

Clinical diagnostic features of Keegan′s disease

目的探讨Keegan型颈椎病的临床诊断学特征及误诊原因。方法收集2018年3月至2020年12月空军军医大学空军特色医学中心骨科收治的3例Keegan型颈椎病患者的临床资料,对其诊断、鉴别诊断及转归进行分析,并文献复习。结果3例患者中男性1例,女性2例,年龄分别为36岁、36岁、47岁。均无明显诱因出现右肩部外展活动受限,右上臂上举时外侧酸痛;查体右上肢三角肌、肱二头肌肌力明显降低,不伴有感觉异常和脊髓受损的症状和体征。颈椎MRI T2加权像显示相应神经根运动前支明显受压,呈现典型的选择性异常信号特征;脊髓电生理有明确的三角肌、肱二头肌神经性损害的表现;符合Keegan型颈椎病的临床特征。3例患者采取非手术治疗后,均在起病2~3周后开始好转,起病后11~13周痊愈。结论肩部外展运动功能障碍而无感觉异常是Keegan型颈椎病典型的临床特征。

Objective To explore the clinical diagnostic features and the causes of misdiagnosis of Keegan′s disease.Methods3 patients with Keegan's disease treated in Orthopedics Department of Air Force Medical Center Affiliated to Air Force Medical University from March 2018 to December 2020 were selected.Their diagnosis,differential diagnosis and outcomes were analyzed,and the relevant literatures were reviewed.ResultsThere were 3 patients,1 male and 2 females,aged 36,36 and 47 years old,respectively.All the patients had restricted abduction of the right shoulder without obvious inducement,and lateral soreness when lifting the right upper arm.The muscle strength of deltoid muscle and biceps brachii of the right upper limb was significantly reduced,with no symptoms and signs of spinal cord damage and paresthesia.There were typical selective"high spots"in MRI T2WI,and clear neurological damage of the deltoid and biceps in electrophysiology,in line with all the clinical features of Keegan′s disease.With conservation treatment,all patients began to get better 2 to 3 weeks and recovered 11 to 13 weeks after onset.ConclusionShoulder abductor dysfunction without paresthesia is a typical clinical feature of Keegan′s disease.