Chiari畸形合并神经性关节病38例临床分析

Neuropathic arthropathy caused by Chiari malformation

目的 探讨Chiari畸形合并神经性关节病的相关因素和发病机制.方法 回顾性分析38例Chiari畸形合并神经性关节病患者的临床资料,总结其发病特点、发病部位、临床表现、影像学表现和手术治疗等情况.结果 病程长短、上肢肌肉是否萎缩与神经性关节病的发生有关.经枕颈减压术或空洞分流术治疗后,18例患者关节症状改善.结论 上肢肌肉萎缩和病程较长是神经性关节病的危险因素.治疗上以手术治疗原发病为主,辅以关节局部功能锻炼和药物治疗.

Objective To discuss the relative pathogenic factors and mechanisms of neuropathic arthropathy caused by Chiari malformation. Method 309 cases with Chiari malformation in the third hospital of Peking University from 1998 to 2008 were reviewed, and there were 38 cases with neuropathic arthropathy. The general conditions, affected joints, clinical manifestation, radiology and operations were summarized. Results There were remarkable relationship between course of disease, upper limb muscle atrophy and neuropathic arthropathy. After the operations of occipital - cervical decompression or syrinx shunting,18 patients improved in arthropathy. Conclusions Patients with atrophy of upper limb muscles may be prone to neuropathic arthropathy. At the same time, the course of disease is another risk factor. Treatment includes operations on primary diseases,functional exercise of affected joints and drug therapy.