Pham X V, Bancel P, Menkès C J, Kahan A
Service de rhumatologie A, h pital Cochin, université René-Descartes Paris V, France.
Joint Bone Spine. 2000;67(5):434-40.
To evaluate the efficacy of upper cervical spine surgery in symptomatic atlantoaxial instability due to rheumatoid arthritis (RA).
Thirty RA patients (29 women and one man) with a mean age of 56 years were studied retrospectively. Symptomatic forward slippage of the atlas on the axis with a synovial pannus surrounding the odontoid and magnetic resonance imaging evidence of spinal cord compression was present in all 30 patients; 18 patients had vertical translocation of the odontoid and 14 had basilar invagination. Surgery, performed between 1991 and 1997, consisted of occipitocervical fusion in 18 patients and atlantoaxial fusion in 12. Cotrel-Dubousset instrumentation was performed in all 30 patients.
Mean follow-up was four and a half years. All patients were satisfied with the procedure and exhibited marked functional gains and objective neurological improvement (by one class in the Ranawat scheme). Stable fusion was documented in all 30 patients.
Cervical instrumentation and bone grafting seems to provide functional and neurological gains in carefully selected RA patients with atlantoaxial instability and spinal cord compression. Long term follow-up suggests that the benefits are sustained and that morbidity is low.
评估上颈椎手术治疗类风湿关节炎（RA）所致症状性寰枢椎不稳的疗效。
对30例RA患者（29例女性，1例男性）进行回顾性研究，平均年龄56岁。所有30例患者均有症状性寰椎相对于枢椎的前滑脱，伴有齿状突周围的滑膜血管翳，以及脊髓受压的磁共振成像证据；18例患者有齿状突垂直移位，14例有基底凹陷。手术于1991年至1997年间进行，18例行枕颈融合术，12例行寰枢椎融合术。所有30例患者均采用Cotrel-Dubousset器械固定。
平均随访4.5年。所有患者对手术满意，功能明显改善，神经功能客观改善（根据Ranawat分级提高一级）。所有30例患者均证实融合稳定。
对于精心挑选的伴有寰枢椎不稳和脊髓受压的RA患者，颈椎器械固定和植骨似乎能改善功能和神经功能。长期随访表明疗效可持续且并发症发生率低。
