Romeyn R L, Herkowitz H N
Clin Orthop Relat Res. 1986 Sep(210):113-9.
Fifty-three patients with known hemophilia A or B were retrospectively reviewed to determine the incidence of cervical spine involvement. Twenty-five were examined prospectively, including a detailed history and physical examination and cervical spine roentgenograms consisting of an AP and lateral flexion-extension series. All roentgenograms were reviewed by a board-certified radiologist. The mean age of patients in both groups was 25.4 years (range, eight to 54 years). In the retrospective review, no patients were noted to have complaints referable to the cervical spine, although five patients had prior trauma to the cervical spine. In the prospective study, 8 of 25 patients complained of intermittent neck discomfort and 9 of 25 had restricted lateral rotation and/or lateral flexion. No patient had radicular symptoms or objective neurologic deficits. Roentgenograms showed abnormalities in 13 of 25 patients. Ten patients (aged 19 to 54 years; mean, 32 years) showed cystic changes or endplate irregularity within one or more vertebral bodies. Two patients, aged 15 to 19 years, had an increased atlanto-dens interval of 5 mm (normal, 3 mm). No odontoid erosion was noted. No correlation was found between the severity of peripheral involvement and the cervical spine roentgenograms. Occult instability of the cervical spine is discussed, along with ramifications for patients with hemophilia.
对53例已知患有甲型或乙型血友病的患者进行回顾性研究，以确定颈椎受累的发生率。对25例患者进行了前瞻性检查，包括详细的病史、体格检查以及颈椎正位和侧位屈伸位X线片。所有X线片均由一名获得委员会认证的放射科医生进行评估。两组患者的平均年龄为25.4岁（范围为8至54岁）。在回顾性研究中，尽管有5例患者既往有颈椎外伤史，但未发现有患者有颈椎相关的主诉。在前瞻性研究中，25例患者中有8例主诉间歇性颈部不适，25例中有9例存在侧向旋转和/或侧向屈曲受限。没有患者出现神经根症状或客观的神经功能缺损。X线片显示25例患者中有13例存在异常。10例患者（年龄19至54岁；平均32岁）在一个或多个椎体中出现囊性改变或终板不规则。2例年龄15至19岁的患者寰齿间隙增加了5毫米（正常为3毫米）。未发现齿状突侵蚀。未发现外周受累的严重程度与颈椎X线片之间存在相关性。文中讨论了颈椎的隐匿性不稳定以及对血友病患者的影响。
