Toyama Y, Hirabayashi K, Fujimura Y, Satomi K
Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
Spine (Phila Pa 1976). 1992 Oct;17(10 Suppl):S436-41. doi: 10.1097/00007632-199210001-00016.
Six cases of spontaneous fracture of the odontoid process in rheumatoid arthritis are presented. Fifty-one patients with atlantoaxial subluxation in rheumatoid arthritis underwent surgery between 1981 and 1990. This included six patients (in 10%) who had subluxation accompanied by fracture of the odontoid without apparent trauma. The mean patient age was 58 years and all had a long history of rheumatoid arthritis. No trauma was considered to be the cause of the fracture. This is a fracture caused by erosion and osteoporosis of the odontoid process due to rheumatoid synovitis, aging and steroid therapy. In addition, another cause is a dynamic load produced from the instability accompanying atlantoaxial subluxation working on the odontoid in cervical extension. It is important remember that the odontoid process is susceptible to spontaneous fracture.
本文报告了6例类风湿关节炎患者发生的齿状突自发性骨折。1981年至1990年间，51例类风湿关节炎伴寰枢椎半脱位的患者接受了手术。其中6例患者（占10%）发生了半脱位并伴有齿状突骨折，且无明显外伤。患者平均年龄为58岁，均有类风湿关节炎病史。骨折原因未考虑外伤。这是一种由类风湿滑膜炎、衰老及类固醇治疗导致的齿状突侵蚀和骨质疏松引起的骨折。此外，另一个原因是寰枢椎半脱位伴有的不稳定在颈椎伸展时作用于齿状突产生的动态负荷。重要的是要记住，齿状突易发生自发性骨折。
