Hartlev Louise Brøndt, Gudmundsdottir Gudrun, Mosdal Claus, Stengaard-Pedersen Kristian
Arhus Universitetshospital, Arhus Sygehus, Reumatologisk Afdeling, Arhus C.
Ugeskr Laeger. 2008 Feb 18;170(8):647-50.
The aim of the study was to study pre- and postoperative symptoms, radiological findings and operative complications in rheumatoid arthritis (RA) patients, operated in the atlantoaxial joint.
A retrospective study of 31 RA patients (24 women, seven men) operated for anterior atlantoaxial subluxation (aAAS) at the Neurosurgical Department, Aarhus University Hospital, in the period of 1993-2003. Information was obtained retrospectively from the patients charge.
Mean age at RA debut was 38 years (16-69 yrs), and neck symptoms were seen after a mean time of 15 years (0-39 yrs) of illness. Radiological examination at this time showed irreversible atlantoaxial changes, and operation was performed within 0-9 years (mean 1.6 yrs). The patients were characterized by high disease activity: C-reactive protein, anaemia, positive IgM-rheumatoid factor (84%), and progressive radiological changes in the peripheral joints. All patients were treated with DMARDs (disease modifying anti rheumatic drugs). Neck pain (100%) and neurological symptoms/manifestations (87%) were seen preoperatively. After operation symptoms were relieved in 68% of the patients, while 22% were unchanged, and 10% had worsened. Postoperative complications included cardiac death, dislocation of the cervical spine, fracture of arcus atlantis, hemiparesis, dysphagia, bed sores and infection of the surgical scar (29%).
Neck symptoms were seen after 15 years of illness, and within the following 1.6 years patients were operated for aAAS. After the operation most of the patients (68%) had relief from symptoms, while 29% had postoperative complications, including cardiac death, dislocation of the cervical spine, fracture of arcus atlantis, hemiparesis, dysphagia, bed sores and infection in the surgical scar.
本研究旨在探讨类风湿关节炎（RA）患者寰枢关节手术后的术前及术后症状、影像学表现和手术并发症。
对1993年至2003年间在奥胡斯大学医院神经外科接受前路寰枢椎半脱位（aAAS）手术的31例RA患者（24例女性，7例男性）进行回顾性研究。通过回顾患者病历获取信息。
RA发病时的平均年龄为38岁（16 - 69岁），发病后平均15年（0 - 39年）出现颈部症状。此时的影像学检查显示寰枢椎有不可逆改变，手术在发病后0 - 9年（平均1.6年）内进行。患者的特点为疾病活动度高：C反应蛋白升高、贫血、IgM类风湿因子阳性（84%），且外周关节有进行性影像学改变。所有患者均接受改善病情抗风湿药（DMARDs）治疗。术前出现颈部疼痛（100%）和神经症状/体征（87%）。术后68%的患者症状缓解，22%无变化，10%症状加重。术后并发症包括心源性死亡、颈椎脱位、寰椎弓骨折、偏瘫、吞咽困难、褥疮和手术切口感染（29%）。
发病15年后出现颈部症状，随后1.6年内患者接受aAAS手术。术后大多数患者（68%）症状缓解，但29%出现术后并发症，包括心源性死亡、颈椎脱位、寰椎弓骨折、偏瘫、吞咽困难、褥疮和手术切口感染。
