本文選題：類風濕性關節(jié)炎 + 寰樞椎脫位�。� 參考：《中國脊柱脊髓雜志》2017年04期

【摘要】：目的 :評估后路內(nèi)固定融合節(jié)段對治療類風濕性寰樞椎不穩(wěn)臨床療效的影響。方法 :2008年1月~2015年3月收治類風濕性寰樞椎不穩(wěn)患者24例,其中女15例,男9例;年齡37~64歲(50.8±4.3歲)。21例患者入院前已經(jīng)診斷為類風濕性關節(jié)炎(RA),病程2~30年(15.6±7.8年);3例患者本次入院確診為RA并且伴有寰樞椎不穩(wěn)。側(cè)位X線片示寰樞椎脫位(AAS)13例;寰樞椎垂直脫位(VS)5例;AAS+VS 2例;AAS+下頸椎半脫位(SAS)1例;后路鋼絲固定術后3年鋼絲斷裂合并下頸椎SAS 1例;寰樞關節(jié)破壞無脫位表現(xiàn)2例。均行后路固定融合手術,13例AAS患者10例行后路寰樞椎(C1-2)融合內(nèi)固定術,2例因C2椎弓根細小行C1-C3固定融合,1例因寰椎后弓細小及骨質(zhì)疏松行枕頸融合術(O-C2);7例VS/AAS+VS患者及2例嚴重枕頸部疼痛的患者行枕頸融合術,O-C2融合3例,O-C3融合6例,其中1例行寰椎后弓切除減壓;2例合并SAS的患者行枕頸椎/胸椎(O-C7 1例,O-T1 1例)固定融合,包括1例翻修手術。比較患者術前、術后及末次隨訪時的Ranawat神經(jīng)功能分級、VAS和JOA評分。結果 :24例患者手術均順利完成,無術中并發(fā)癥;術后傷口淺表感染2例,經(jīng)換藥和使用敏感抗菌素治愈。24例患者均獲得隨訪,隨訪時間12~45個月(24.1±10.3個月)。VAS評分由術前的6.6±1.2分下降到術后的2.6±0.9分,末次隨訪時1.8±0.7分(P0.05)。JOA評分由術前的平均11.5±1.9分增加到術后的平均13.6±2.0分,末次隨訪時14.5±1.1分(P0.05)。Ranawat神經(jīng)損傷分級:3例術前Ⅰ級無恢復;5例Ⅱ級者4例恢復至Ⅰ級,1例無恢復;15例Ⅲa級恢復至Ⅰ級13例,Ⅱ級2例;1例Ⅲb級恢復至Ⅲa級。術后3個月植骨融合率為29%(7例),術后6個月為79%(19例),術后12個月為100%(24例)。術后繼發(fā)SAS 3例,脫位部位:C3/4 2例,C4/5 1例。結論:類風濕性寰樞椎不穩(wěn)患者行后路內(nèi)固定融合手術治療效果滿意,應根據(jù)病變累及范圍、脫位類型、骨密度和釘?shù)狼闆r選擇固定融合范圍。
[Abstract]:Objective: to evaluate the effect of posterior internal fixation fusion on rheumatoid atlantoaxial instability. Methods: from January 2008 to March 2015, 24 patients with atlantoaxial instability were treated, including 15 females and 9 males. Patients aged 370.64 years (50.8 鹵4.3 years) had been diagnosed as rheumatoid arthritis (RA) before admission. The course of disease ranged from 2 to 30 years (15.6 鹵7.8 years) and 3 patients were diagnosed as RA with atlantoaxial instability. Lateral radiographs showed atlantoaxial dislocation in 13 cases, atlantoaxial dislocation in 5 cases (VS) in 5 cases, AAS VS in 2 cases with AAS subluxation of cervical spine in 1 case, posterior wire fixation in 1 case after 3 years of fixation with SAS of lower cervical vertebrae, atlantoaxial joint failure in 2 cases, and no dislocation of atlantoaxial joint in 2 cases. Posterior fixation fusion was performed in 13 patients with AAS and 10 patients with posterior atlantoaxial C1-2) internal fixation was performed in 2 patients with small C2 pedicle and 1 case with occipitocervical fusion due to small posterior arch of atlas and osteoporosis. 7 patients with VS- AAS VS were diagnosed by occipitocervical fusion. Patients and 2 patients with severe occipitocervical pain underwent occipitocervical fusion with O-C2 fusion in 3 cases and O-C 3 fusion in 6 cases. One patient underwent posterior arch resection and decompression of atlas and 2 patients with SAS underwent occipitocervical / thoracic vertebrae O-C 7 (n = 1) fixation and fusion, including revision surgery (n = 1). The VAS and JOA scores of Ranawat neurological function grading were compared before, after operation and at the last follow-up. Results all the 24 cases were successfully operated without intraoperative complications, 2 cases of superficial wound infection were cured by dressing change and sensitive antibiotics, and 24 cases were followed up. The follow-up time ranged from 24.1 鹵10.3 months to 2.6 鹵0.9, from 6.6 鹵1.2 to 2.6 鹵0.9, and at the last follow-up, the score of 1.8 鹵0.7, P0.05 and JOA increased from 11.5 鹵1.9 to 13.6 鹵2.0, respectively. At the last follow-up, 14.5 鹵1.1 min. P 0.05U .Ranawat nerve injury grade: 3 cases had no recovery in grade 鈪，

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