Crim J R, Bassett L W, Gold R H, Mirra J M, Mikulics M, Dawson E G, Eckhardt J J
Department of Radiology, UCLA Medical Center 90024.
AJNR Am J Neuroradiol. 1988 Mar-Apr;9(2):359-62.
Spinal neuroarthropathy is a little-known complication of traumatic paraplegia. Four cases of this syndrome are described, with emphasis on the characteristic radiographic findings of severe juxta-articular bone destruction, dense appositional new bone formation, large osteophytosis, and soft-tissue bony debris. The factors predisposing patients to develop a neuropathic joint are diminished pain and proprioceptive sensations with maintained mobility. When a paraplegic patient transfers in or out of a wheelchair or moves his upper torso, he exerts force on an insensate spine. Repeated trauma increases joint mobility beyond the normal limits, and this leads to further damage, with the process culminating in severe instability and bone destruction. The other causes of neuropathic joints in the spine--tertiary syphilis, syringomyelia, and diabetes--must be ruled out on clinical grounds. Neuropathic changes in the spine are often silent, delaying treatment, or may be mistaken for infection or degenerative disease. Their true prevalence is difficult to determine, but the possibility should be considered in paraplegic patients with the characteristic radiographic findings.
脊髓神经关节病是创伤性截瘫一种鲜为人知的并发症。本文描述了4例该综合征，重点关注严重的关节旁骨质破坏、致密的贴附性新骨形成、大量骨赘形成及软组织骨碎片等特征性影像学表现。使患者易患神经性关节的因素是疼痛和本体感觉减退而活动能力尚存。截瘫患者进出轮椅或移动上半身时，会对无感觉的脊柱施加力。反复创伤使关节活动超出正常限度，进而导致进一步损伤，最终导致严重不稳定和骨质破坏。脊柱神经性关节的其他病因——三期梅毒、脊髓空洞症和糖尿病——必须根据临床情况排除。脊柱的神经病变往往没有症状，延误治疗，或可能被误诊为感染或退行性疾病。其真实患病率难以确定，但对于有特征性影像学表现的截瘫患者应考虑到这种可能性。
