摘要
目的总结类风湿关节炎(rheumatoid arthritis,RA)伴颈椎半脱位患者的临床特点,提高对该病的认识和警惕性。方法选取RA伴颈椎半脱位64例作为RA伴颈椎半脱位组,另选取RA无颈椎半脱位192例作为RA无颈椎半脱位组,分析RA伴颈椎半脱位临床表现,比较两组临床资料、实验室指标及治疗、RA疾病活动度、RA关节影像学检查情况。结果本研究入选的RA伴颈椎半脱位64例,最常见形式为寰枢椎前后脱位(AAS)(90. 6%,58/64),其次分别为垂直半脱位(VS)(20. 3%,13/64)、下颈椎半脱位(SAS)(4. 7%,3/64)。RA伴颈椎半脱位患者78. 1%(50/64)有颈痛,伴颈椎活动受限、枕后放射样疼痛;15. 6%(10/64)有脊髓、神经根损伤症状和体征;另有7. 8%(5/64)存在椎基底动脉供血不足症状。RA伴颈椎半脱位组较RA无颈椎半脱位组年龄小、病程长、大关节及小关节受累数目多及长时间使用糖皮质激素治疗率高,两组比较差异有统计学意义(P <0. 05)。RA伴颈椎半脱位组骨侵蚀评分及X线下骨质破坏率均高于RA无颈椎半脱位组,差异有统计学意义(P <0. 05)。结论对于发病年龄小、病程长、关节受累数目较多(尤其是大关节受累)、外周关节骨破坏明显及长时间使用糖皮质激素治疗的RA患者,需警惕颈椎半脱位。
Objective To investigate the clinical features of rheumatoid arthritis （RA） patients with cervical subluxations. Methods A total of 64 RA patients with cervical subluxations were selected as RA combined with cervical subluxations group and the other 192 patients without cervical subluxations as non-subluxation group. The clinical manifestations were analyzed in both groups, and the clinical data, laboratory parameters and treatment, joint mobility after development of RA disease, and radiographic data of the joint of those with RA were compared between the two groups. Results For 64 RA patients with cervical subluxations, the most frequent instabilities were atlantoaxial subluxation （AAS, 90.6%, 58/64）, followed by vertical subluxation （VS, 20.3%,13/64）, and subaxial subluxation （SAS, 4.6%, 3/64）. Neck pain was a common symptom （78.1%, 50/64）, accompanied by restricted movement of the cervical vertebra or post-occipital radiation pain. 15.6% （10/64） patients had the symptoms and signs of injured spinal cord or nerve root. Other symptoms caused by vertebral basilar artery insufficiency accounted for 7.8% （5/64）. This study confirmed RA patients with cervical subluxations had significantly younger age at disease onset, longer disease duration, more joint involvement （both large and small joints）, and higher frequency of long-term corticosteroids treatment, compared to non-subluxation group （ P 〈0.05）. Cervical subluxations group had significantly higher sum score of erosion evaluated by ultrasound, higher frequency of peripheral joint erosions evaluated by X-ray when compared to the non-subluxation group, and there were significant differences （ P 〈0.05）.
Conclusion This study has confirmed that patients with a younger age at RA onset, longer RA disease duration, more joints involvement （especially large joints）, remarkable peripheral joints erosions, and long-term corticosteroids treatment, are more likely to develop cervical subluxations.
作者
邓丽
李敬扬
文振华
田锋
罗筱雯
张靓
DENG Li;LI Jing-yang;WEN Zhen-hua;TIAN Feng;LUO Xiao-wen;ZHANG Liang(Department of Rheumatology,Zhuzhou Central Hospital,Zhuzhou,Hunan 412000,China)
出处
《临床误诊误治》
2018年第11期80-85,共6页
Clinical Misdiagnosis & Mistherapy
基金
湖南省自然科学基金(青年基金)项目(2017JJ3532)
关键词
关节炎
类风湿
半脱位
颈椎
Arthritis
rheumatoid
Subluxations
Cervical vertebrae
