Marques P M, Cacho-Rodrigues P, Ribeiro-Silva M, Linhares D, Negrão P, Pinto R, Neves N
Acta Reumatol Port. 2015 Jan-Mar;40(1):34-9.
Cross-sectional study that aims to evaluate the results of cervical spine surgeries due to rheumatoid arthritis (RA) instability, between January of 2000 and of 2012 in a main Portuguese centre.
Patients followed on Rheumatology submitted to cervical spine fusion due to atlantoaxial (AAI), sub-axial (SAI) or cranio-cervical (CCI) instabilities between 2000-2012 were included. Information about the surgical procedure and associated complications was gathered and imagiologic and clinical indexes before and after surgery (as anterior and posterior atlanto-axial interval and Ranawat index) were evaluated and compared using adequate statistics.
Forty-five patients with RA were included: 25 with AAI, 13 with CCI and 7 with SAI. Ten AAI and 4 CCI patients were submitted to wiring stabilization techniques; 15 AAI and 9 CCI patients to rigid ones; and in all patients with SAI an anterior cervical arthrodesis was chosen. There is a significant increase in PADI and a decrease in AADI in the postoperative evaluation (p<0,05) that only remains significant when rigid systems were used. After surgery the Ranawat index decreased (p<0,05) and no patient showed a deterioration of neurological condition. The complication rate was of 23,1%, with 5 mal-unions.
Surgical management of cervical column instabilities in patients with rheumatoid arthritis seems to be a safe procedure, with a high rate of neurologic improvement. Rigid techniques seem to lead to a better imagiological improvement when compared to wiring ones.
这是一项横断面研究，旨在评估2000年1月至2012年期间，在葡萄牙一家主要中心因类风湿性关节炎（RA）不稳定而进行的颈椎手术结果。
纳入2000年至2012年间在风湿病科接受治疗，因寰枢椎（AAI）、下颈椎（SAI）或颅颈（CCI）不稳定而接受颈椎融合术的患者。收集有关手术过程及相关并发症的信息，并使用适当的统计学方法评估和比较手术前后的影像学和临床指标（如寰枢椎前后间隙和拉纳瓦特指数）。
纳入45例类风湿性关节炎患者：25例为AAI，13例为CCI，7例为SAI。10例AAI和4例CCI患者采用钢丝固定技术；15例AAI和9例CCI患者采用刚性固定技术；所有SAI患者均选择前路颈椎融合术。术后评估中，PADI显著增加，AADI显著降低（p<0.05），仅在使用刚性固定系统时仍具有显著性。术后拉纳瓦特指数降低（p<0.05），且无患者神经功能恶化。并发症发生率为23.1%，其中5例骨不连。
类风湿性关节炎患者颈椎不稳的手术治疗似乎是一种安全的手术方法，神经功能改善率较高。与钢丝固定技术相比，刚性固定技术似乎能带来更好的影像学改善。
