上颈椎类风湿关节炎与脊髓损伤

Rheumatoid arthritis of the upper cervical spine and spinal cord injury

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.

Objective To investigate the results of surgical treatment of occipitocervical or atlantoaxial segment involvedin rheumatoid arthritis through posterior approach fusion with graft and internal fixation, Methods The severity of neurological damage was classified into three groups according to Ranawat： 5 patients in Grade Ⅱ , 10 in Grade ⅢA and 2 in Grade ⅢB. Seventeen patients of occipitocervical or atlantoaxial region involved in rheumatoid arthritis were treated with posterior approach fi,sion with graft and internal fixation. Four patients with vertical suhluxation and four patients with irreducible anterior atlantoaxial subluxation were treated with oceipitocervical fusion combined with laminectomy of the atlas or decompression of the foramen magnum, and 9 patients were treated with atlantoaxial fusion with titanium wiring as the anterior atlantoaxial subluxation could be reduced. Results With mean follow-up period of 3.5 years （ range 1.5-7.5 years）, satisfactory stabilization of the atlantoaxial or occipitocervical segment was achieved in all 17 patients without any complication, and radiographic assessments demonstrated complete osseous union. Neurological improvement was observed in 15 patients after operation, except that 2 patients remained their original neurologic deficit. Conclusion Early stabilization of atlantoaxial or occipitocervical segment may be able to effectively decrease the risk of the inflammatory, process with destruction and progression of cervical instability, and their periodontoid pannuses had been obviously diminished during follow-up examination in spite of the ongoing course of the disease.