Kobayashi Takashi, Miyakoshi Naohisa, Konno Norikazu, Ishikawa Yoshinori, Noguchi Hideaki, Shimada Yoichi
Department of Orthopedic Surgery, Akita Kousei Medical Center, Akita, Japan.
Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
Asian Spine J. 2018 Dec;12(6):1117-1122. doi: 10.31616/asj.2018.12.6.1117. Epub 2018 Oct 16.
Prospective study.
To assess the prevalence of periodontoid calcification and its associations with acute cervical pain.
Calcium pyrophosphate dihydrate (CPPD) deposition disease is a common rheumatological disorder that occurs especially in elderly patients. Although CPPD crystals induce acute arthritis, these crystals are not usually symptomatic. Calcification surrounding the odontoid process (periodontoid calcification) has been reported to induce inflammation, resulting in acute neck pain. This disease is called crowned dens syndrome. Whether calcification induces inflammation or whether the crystals are symptomatic remains unclear.
The prevalence of periodontoid calcification at the atlas transverse ligament was examined by computed tomography of the upper cervical spine in patients suspected of brain disease but no cervical pain (control group, n=296), patients with pseudogout of the peripheral joints but no cervical pain (arthritis group, n=41), and patients with acute neck pain (neck pain group, n=22). Next, the correlation between the prevalence of periodontoid calcification and symptoms was analyzed.
In the control group, 40 patients (13.5%) showed periodontoid calcification with no significant difference in the prevalence with gender. The prevalence of calcification increased significantly with age (p=0.002). In the arthritis group, 26 patients (63.4%) reported periodontoid calcification. In the neck pain group, 14 patients (63.6%) reported periodontoid calcification. Multiple logistic regression analysis by age and group revealed that higher age, inclusion in the arthritis group, and inclusion in the neck pain group significantly affected the prevalence of calcification.
Our results cumulatively suggest that periodontoid calcification is an aging-related reaction and that calcification per se does not always cause neck pain. Periodontoid calcification was observed more frequently in patients with pseudogout of the peripheral joints and in those with acute neck pain than in asymptomatic control patients.
前瞻性研究。
评估齿突周围钙化的患病率及其与急性颈部疼痛的关联。
二水焦磷酸钙（CPPD）沉积病是一种常见的风湿性疾病，尤其多见于老年患者。尽管CPPD晶体可诱发急性关节炎，但这些晶体通常并无症状。据报道，齿突周围钙化（齿突周围钙化）可诱发炎症，导致急性颈部疼痛。这种疾病被称为齿突冠综合征。钙化是否诱发炎症或晶体是否有症状尚不清楚。
通过对疑似脑部疾病但无颈部疼痛的患者（对照组，n = 296）、外周关节假性痛风但无颈部疼痛的患者（关节炎组，n = 41）以及急性颈部疼痛患者（颈部疼痛组，n = 22）进行上颈椎计算机断层扫描，检查寰椎横韧带处齿突周围钙化的患病率。接下来，分析齿突周围钙化患病率与症状之间的相关性。
在对照组中，40例患者（13.5%）出现齿突周围钙化，患病率在性别上无显著差异。钙化患病率随年龄显著增加（p = 0.002）。在关节炎组中，26例患者（63.4%）报告有齿突周围钙化。在颈部疼痛组中，14例患者（63.6%）报告有齿突周围钙化。按年龄和组进行的多因素逻辑回归分析显示，年龄较大、纳入关节炎组和纳入颈部疼痛组显著影响钙化患病率。
我们的结果累积表明，齿突周围钙化是一种与年龄相关的反应，钙化本身并不总是导致颈部疼痛。与无症状的对照患者相比，外周关节假性痛风患者和急性颈部疼痛患者中齿突周围钙化的观察频率更高。
