寰枢关节类风湿性关节炎的影像学分析(附21例报告)

Imaging analysis of atlantoaxial in rheumatoid spondylitis(21 cases report)

目的评估累及寰枢关节的21例RA患者经联合治疗的临床效果及其影像学特征。方法对平均病程为7.95年(2～26年)的21例患者行MTX+其他DMARDs的联合治疗,同时行临床和影像学评估,明确16例存在寰枢椎前向半脱位、3例垂直半脱位、2例侧方半脱位。6例有明显枕颈部症状的寰枢不稳患者行后路寰枢或枕颈融合治疗。结果联合治疗的有效率为85.7%。RA病程越长,越易发生寰枢椎不稳和椎管矢状径减小,本组前向寰枢椎半脱位最常见。6例手术患者的齿突周围血管翳在随访中较术前明显减小。结论对累及寰枢关节的RA患者,无论有无寰枢椎不稳、有无症状或脊髓损伤的体征,均可成功行影像学评估且行MTX+其他DMARDs的联合治疗可取得较好的疗效;为防止枕颈部脊髓压迫,宜对此类患者行常规、定期的临床和影像学评估。

Objective To investigate the therapeutic effect of combination therapy and the imaging characteristics of twenty-one patients with atlantoaxial rheumatoid spondylitis. Methods 21 patients with rheumatoid arthritis of atlantoxial joint,who underwent combination therapy of MTX with some other DMARDs,were clinically and radiologically examined with mean disease duration for 7.95 years （2-26 years）. Forward atlantoaxial subluxation was verified in 16 cases with a range from 3mm to 15mm, and vertical subluxation in 3 cases and lateral subluxation in 2 cases. Six patients with craniovertebral symptoms underwent posterior atlantoaxial or craniovertebral fixation and fusion due to severe instability. Result Effective rate of combination therapy was 85.7%. Atlantoaxial subluxation were the most specific and established the association among duration of disease,atlantodental instability and sagittal spinal canal diameter diminished. After immobilization of the atlantoaxial or craniovertebral segment in 6 patients,their peridental pannuses had been obviously diminished during follow-up examination in spite of the ongoing systemic course of the disease. Conclusion Patients with atlantoaxial joints involvement in RA,either with or without C1-C2 instability,who have either symptoms or neurological signs may be managed with imaging surveillance and combination therapy of MTX with some other DMARDs has good therapeutic effect for moderate-to-severe RA. We suggest periodical,routine clinical and radiological examination of patients with registered involvement of the atlantoaxial joints in RA to follow-up spatial anatomic changes in order to prevent craniovertebral medullary compression.