颈椎类风湿性关节炎患者的影像学分期及其功能评估  

Radiological staging and functional evaluation of patients with cervical spinal involvement in rheumatoid arthritis

作　　者：邱一华[1] 谭俊铭[2] 骆合德[1] 冯水云[2] 邢顺民[2] 冯金忠[1] 程训民[1] 

机构地区：[1]解放军第九十八医院内科,浙江省湖州市313000 [2]解放军第九十八医院骨一科,浙江省湖州市313000

出　　处：《中国组织工程研究与临床康复》2007年第5期920-922,共3页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：解放军南京军区医药卫生科研基金资助项目(06MA13)~~

摘　　要：目的:探讨临床和影像学分期及评估对指导颈椎类风湿性关节炎患者治疗的意义。方法:选择1995-01/2004-07解放军第98医院住院治疗累及颈椎的类风湿性关节炎患者21例,平均病程8.0年。①所有患者常规摄颈椎或颅颈部正侧位、屈/伸侧位片及开口位片和枕颈部CT平扫,疑神经损伤者行MRI检查。②临床和影像学分期显示Ⅱ期(中度进展期)5例和Ⅲ期(重度进展期)16例;神经系统评估按Ranawat等标准(级别越高,神经损害越重)示Ⅰ级4例,Ⅱ级11例、ⅢA级4例、ⅢB级2例。③21例患者行甲氨蝶呤+其他DMARDs的联合治疗,Ranawa分级Ⅰ级4例行颈围外固定,11例Ⅱ级患者行枕颌吊带牵引,Ⅲ级6例手术行后路寰枢或枕颈融合治疗。④出院和随访时行临床疗效评估。结果:21例均进入结果分析。①影像学结果显示前向寰枢椎半脱位最常见,有16例,与侵蚀性骨破坏累及寰枢、寰齿、寰枢关节有关。②平均随访5.6年,21例中缓解2例,显效12例,有效4例,无效3例。③6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:对颈椎类风湿性关节炎患者可成功行临床和和影像学分期及评估,根据评估结果指导临床治疗效果满意。提示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随访。AIM： To investigate the significance of clinical and radiological staging and evaluating for the patients with rheumatoid arthritis who are registered involvement of the cervical spine. METHODS： From January 1995 to July 2004, 21 patients with rheumatoid arthritis who were registered involvement of the cervical spine and treated in the 98 Hospital of Chinese PLA were selected with the average illness course of 8.0 years. （1）The patients were made anteroposterior and lateral position, flexion/extension plain film, poen-mouth view of radiological examinations, and CT scanning of the occipitocervical or craniocarvical region. The patients suspected with neurological damage were given MRI examination. （2）Clinical and radiological staging showed that there were 5 patients classified as stage Ⅱ （moderate progression） and 16 as stage Ⅲ （severe progression）; The severity of neurological damage was classified according to the standards of Ranawat et al （the higher the grade, the severer the damage）, and 4 patients were classified as Ⅰ, 11 as Ⅱ, 4 as Ⅲ A and 2 as Ⅲ B. （3）All patients underwent the combined therapy of methotrexate plus other DMARDs, and 4 cases of grade Ⅰ in Ranawa classification were subjected to neck collar fixation, 11 cases of grade Ⅱ to cervical suspender traction and 6 of grade Ⅲ to posterior atlantoaxial or craniovertebral fixation and fusion therapy. （4）Clinical efficacy evaluation was conducted after the patients discharged and during follow up. RESULTS： All 21 patients were involved in the result analysis. （1）The imageology showed that forward atlantoaxial subluxation was verified in 16 cases, which was related with erosive osteoclasia in the atlantoaxial, atlanto-odontoid and atlanto-occipital joints. （2）Dudng the follow up of 5.6 years, 2 cases of 21 ones were relieved, 12 were favorite, 4 were effective and 3 were ineffective. （3）The peridental pannuses of six patients had been obviously diminished during the follow-up examinat

关 键 词：颈椎 类风湿关节炎 寰枢椎不稳 有效脊髓空间 影像学 

分 类 号：R318[医药卫生—生物医学工程]