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1、脊柱外科杂志,2005年10月,第3卷第5期JSpinalSurg,October2005,Vol3,No5#257##临床研究#上颈椎类风湿关节炎与脊髓损伤谭俊铭,史建刚,严望军,许国华,贾连顺,李家顺【摘要】目的对颈椎类风湿关节炎累及枕颈部或寰枢椎的患者行颈后路植骨融合内固定治疗。方法对本组17例颈椎类风湿关节炎的患者(神经功能损害按Ranawat分级:Ⅱ级5例、ⅢA级10例、ⅢB级2例),行颈后路植骨融合内固定术,其中4例垂直半脱位(VS)患者和4例难复性寰枢椎半脱位(AAS)患者行枕颈减压融合内固定术、9例可复性或复位效果较好的AAS患者行钛缆寰枢椎融合固定术。结果随访1.
2、5~7.5年(平均3.5年),17例均获骨性融合,15例患者的神经功能获不同程度改善,2例虽无改善但亦无神经损伤加重。结论早期寰枢椎或枕颈部稳定手术,似可有效减缓颈椎类风湿关节炎(RA)的炎症破坏过程;同时发现RA病程仍呈进行性,但术后17例患者的齿突周围血管翳较术前明显减小。【关键词】寰枢关节;类风湿关节炎;脊髓损伤;齿后血管翳【中图分类号】R651.21【文献标识码】A【文章编号】1672-2957(2005)05-0257-0260-04*RheumatoidarthritisoftheuppercervicalspineandspinalcordinjuryTANJunmi
3、ng,SHIJiangang,YAN*thWangjun,etal.DepartmentofOrthopaedics,the98HospitalofPLA,Huzhou313000,China【Abstract】ObjectiveToinvestigatetheresultsofsurgicaltreatmentofoccipitocervicaloratlantoaxialsegmentinvolvedinrheumatoidarthritisthroughposteriorapproachfusionwithgraftandinternalfixation.MethodsThe
4、severityofneurologicaldamagewasclassifiedintothreegroupsaccordingtoRanawat:5patientsinGradeⅡ,10inGradeⅢAand2inGradeⅢB.Seventeenpatientsofoccipitocervicaloratlantoaxialregioninvolvedinrheumatoidarthritisweretreatedwithposteriorapproachfusionwithgraftandinternalfixation.Fourpatientswithverticals
5、ubluxationandfourpatientswithirreducibleanterioratlanto-axialsubluxationweretreatedwithoccipitocervicalfusioncombinedwithlaminectomyoftheatlasordecompressionofthefora-menmagnum,and9patientsweretreatedwithatlantoaxialfusionwithtitaniumwiringastheanterioratlantoaxialsubluxationcouldbereduced.Res
6、ultsWithmeanfollow-upperiodof3.5years(range1.5-7.5years),satisfactorystabilizationoftheatlantoaxialoroccipitocervicalsegmentwasachievedinall17patientswithoutanycomplication,andradiographicassessmentsdemonstratedcompleteosseousunion.Neurologicalimprovementwasobservedin15patientsafteroperation,e
7、xceptthat2pa-tientsremainedtheiroriginalneurologicdeficit.ConclusionEarlystabilizationofatlantoaxialoroccipitocervicalsegmentmaybeabletoeffectivelydecreasetheriskoftheinflammatoryprocesswithdestructionandprogressionofcervicalinstability
