Sato K, Senma S, Abe E, Saito H, Saito H
Department of Orthopedic Surgery, Akita University School of Medicine, Japan.
Spine (Phila Pa 1976). 1996 Jun 15;21(12):1467-71. doi: 10.1097/00007632-199606150-00013.
This is a report of two patients who sustained cervical myelopathy that seemed to be associated with hypertrophic atlantodental osteoarthritis accompanying dens hypertrophy.
Pathogenesis of hypertrophic osteoarthritis in the atlantodental articulation was elucidated, and these two patients were treated by C1 decompressive laminectomy with or without posterior fusion.
One case of myelopathy resulting from the hypertrophic nonunion of the dens has been reported, but to the authors' knowledge, there have been no reports describing a case similar to those presented in this report.
History, physical findings, and image examination findings common to the two cases were analyzed to elucidate pathogenesis of hypertrophic osteoarthritis in the atlantodental articulation. C1 decompressive laminectomy alone was performed in one patient and additional atlantoaxial transarticular fixation in the other patient.
Myelopathy in two patients was caused by the cervical cord compressed between the hypertrophic and sclerotic dens and the anteriorly displaced posterior arch of the atlas in the developmentally small atlas ring. Postoperative neurologic recovery was satisfactory with the atlantoaxial solid fusion.
The atlantodental hypertrophic osteoarthritis accompanying the dens hypertrophy seemed to have developed because of post-traumatic atlantoaxial instability. Their developmentally small atlas ring may be a predisposing factor toward the development of myelopathy.
本文报告了两例患有颈椎脊髓病的患者，其似乎与伴有齿状突肥大的肥大性寰齿关节炎相关。
阐明寰齿关节肥大性骨关节炎的发病机制，并对这两名患者采用C1减压椎板切除术并酌情进行后路融合治疗。
已有一例因齿状突肥大性不愈合导致脊髓病的病例报道，但据作者所知，尚无类似本文所述病例的报道。
分析两例患者共有的病史、体格检查结果和影像学检查结果，以阐明寰齿关节肥大性骨关节炎的发病机制。其中一名患者仅接受了C1减压椎板切除术，另一名患者则额外进行了寰枢椎经关节固定术。
两名患者的脊髓病是由于在发育较小的寰椎环中，肥大硬化的齿状突与向前移位的寰椎后弓之间压迫颈髓所致。寰枢椎坚固融合术后神经功能恢复令人满意。
伴有齿状突肥大的寰齿肥大性骨关节炎似乎是由创伤后寰枢椎不稳定发展而来。其发育较小的寰椎环可能是脊髓病发生的一个易感因素。
