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类风湿关节炎患者的颈椎病变

CERVICAL SPINE LESIONS IN RHEUMATOID ARTHRITIS PATIENTS.

作者信息

Macovei Luana-Andreea, Rezuş Elena

出版信息

Rev Med Chir Soc Med Nat Iasi. 2016 Jan-Mar;120(1):70-6.

Abstract

AIM OF THE STUDY

to gather clinical and laboratory data on rheumatoid arthritis patients with cervical spine damage (incidence and prevalence, correlation between duration of disease and the time of lesion onset, to assess signs and symptoms and the role of laboratory investigations). The spine is an axial organ with an important role in support and resistance. It is a pillar with a very complex morphological and functional structure. The vertebral column is crossed by many kinematic chains. The main problem of the cervical spine caused by rheumatoid arthritis is cervical instability which describes all cervical lesions that can lead to neurovascular damage or major disturbance of pain generating statics at movement. The evolving disease shows chronic inflammation of the synovium, which is a self-maintained process and an immunologically induced phenomenon. The chronic inflammation of the synovium forms granulation tissue that invades peripheral joints towards the center and causes ligament cartilage and bone damage.

MATERIAL AND METHODS

The present paper investigated cervical spine lesions in 107 rheumatoid arthritis patients who were admitted to the 1st Rheumatology Clinic of Iasi Rehabilitation Hospital between January 2013 and December 2014. Our study focused on assessing signs and symptoms seen in spine affected by rheumatic disease.

RESULTS AND DISCUSSIONS

the disease causes destructive lesions due to granulomatous infiltration of rachidian structures and medullary sheaths. These lesions lead to damaged discs and instability that produces subluxations and dislocations. The suboccipital region is most affected; in other regions of the spine, high lesions of C4-C5 prevail, where osteolysis damage of spinal apophyses are found. In atlas and axis joints, rheumatoid arthritis causes the inflammation of bursa, synovium and joint capsule and leads to synovial pannus formation. This causes the destruction of cartilage and subchondral bone. Atlantoaxial dislocation is caused by erosive synovitis of atlanto-epistrophic joint, atlanto-odontoid joint and serous bursitis separating the odontoid process from the transverse ligament.

CONCLUSIONS

The dominant symptom of cervical spine damage was pain associated with stiffness and limited joint mobility, muscle stiffness, poor posture.

摘要

研究目的

收集类风湿关节炎颈椎损伤患者的临床和实验室数据(发病率和患病率、病程与损伤发病时间的相关性,评估体征和症状以及实验室检查的作用)。脊柱是一个在支撑和抵抗方面具有重要作用的中轴器官。它是一个形态和功能结构非常复杂的支柱。脊柱由许多运动链穿过。类风湿关节炎引起的颈椎主要问题是颈椎不稳定,它描述了所有可导致神经血管损伤或运动时疼痛产生静力严重紊乱的颈椎病变。疾病进展显示滑膜慢性炎症,这是一个自我维持的过程和免疫诱导现象。滑膜慢性炎症形成肉芽组织,向中心侵入外周关节并导致韧带、软骨和骨损伤。

材料与方法

本文调查了2013年1月至2014年12月期间入住雅西康复医院第一风湿病诊所的107例类风湿关节炎患者的颈椎病变。我们的研究重点是评估风湿性疾病影响的脊柱中出现的体征和症状。

结果与讨论

该疾病由于脊柱结构和髓鞘的肉芽肿性浸润而导致破坏性病变。这些病变导致椎间盘受损和不稳定,进而产生半脱位和脱位。枕下区域受影响最严重;在脊柱的其他区域,C4 - C5的高位病变占主导,在这些部位发现了脊椎附件的骨质溶解损伤。在寰椎和枢椎关节,类风湿关节炎导致滑囊、滑膜和关节囊炎症,并导致滑膜血管翳形成。这会导致软骨和软骨下骨的破坏。寰枢椎脱位是由寰枢关节、寰齿关节的糜烂性滑膜炎以及将齿突与横韧带分开的浆液性滑囊炎引起的。

结论

颈椎损伤的主要症状是与僵硬、关节活动受限、肌肉僵硬、姿势不良相关的疼痛。

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