类风湿性疾病中颅颈交界区受压导致的呼吸异常
Respiratory abnormalities due to craniovertebral junction compression in rheumatoid disease.
作者信息
Howard R S, Henderson F, Hirsch N P, Stevens J M, Kendall B E, Crockard H A
机构信息
Harris Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
出版信息
Ann Rheum Dis. 1994 Feb;53(2):134-6. doi: 10.1136/ard.53.2.134.
OBJECTIVE
To assess the extent and severity of respiratory insufficiency associated with severe rheumatoid atlantoaxial dislocation and its relation to compression of the neuraxis.
METHODS
Twelve patients with severe atlantoaxial dislocation due to rheumatoid disease were studied. Detailed clinical, CT myelography and respiratory assessment including nocturnal oximetry, were performed on all patients.
RESULTS
All patients were severely disabled by their underlying disease but none had symptoms of hypoventilation. All the patients with C1 compression had myelopathic features. Those with medullary deformation (moulding and/or stretch) had abnormal noctural oximetry whilst no significant desaturations were seen in the remaining patients. Post-operative studies showed resolution of noctural desaturations.
CONCLUSION
This study suggests that clinically unsuspected respiratory insufficiency may be common in patients with severe medullary compression associated with rheumatoid atlantoaxial dislocation. It emphasises the importance of careful respiratory monitoring including nocturnal oxygen saturation in patients with major atlantoxial dislocation due to rheumatoid disease.
目的
评估与严重类风湿性寰枢椎脱位相关的呼吸功能不全的程度和严重程度及其与神经轴受压的关系。
方法
对12例因类风湿性疾病导致严重寰枢椎脱位的患者进行了研究。对所有患者进行了详细的临床、CT脊髓造影和呼吸评估，包括夜间血氧饱和度测定。
结果
所有患者均因基础疾病而严重致残，但均无通气不足症状。所有C1受压患者均有脊髓病特征。有延髓变形（塑形和/或拉伸）的患者夜间血氧饱和度测定异常，而其余患者未出现明显的血氧饱和度下降。术后研究显示夜间血氧饱和度下降情况得到缓解。
结论
本研究表明，在与类风湿性寰枢椎脱位相关的严重延髓受压患者中，临床上未被怀疑的呼吸功能不全可能很常见。它强调了对类风湿性疾病导致的严重寰枢椎脱位患者进行仔细的呼吸监测（包括夜间血氧饱和度）的重要性。
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