颈椎类风湿关节炎的外科治疗

Surgical Treatment of Cervical Rheumatoid Arthritis

类风湿关节炎(RA)常累及颈椎,造成颈椎不稳,主要表现为寰枢椎半脱位、垂直半脱位和下颈椎半脱位。该病临床表现各异,易造成误诊、漏诊。诊断主要依赖于影像学检查,选择合适的检查方法有利于早期诊断和治疗,并对手术方案的选择亦有指导作用。颈椎RA的治疗给外科医师带来了巨大挑战,最合适的手术方式亦存在争议,并且围术期需要多学科医师共同协助处理,但予患者早期手术,可有效阻止RA患者颈椎病变的进程和发展,明显改善预后。

Rheumatoid arthritis （RA） often involves the cervical spine, resulting in cervical instability, mainly for atlantoaxial subluxation, vertical dislocation and subluxation of the lower cervical spine. The clinical manifestations of the disease are varied,which may easily lead to misdiagnosis and missed diagnosis. Diagnosis depends mainly on imaging studies, selec- ting the appropriate examination method is conducive to early diagnosis and treatment, and have a guiding role to surgical approach selection. The treatment of cervical spine to the surgeon has brought great challenges, and the most appropriate sur- gical approach is also controversial,and practitioners from different departments are needed for the perioperative treatment, but early surgery can effectively prevent the course of cervical disease in patients with RA, and significantly improve the prognosis.