CAJ | 학술논문

目的了解RA颈椎半脱位的发生情况、临床、实验室和影像学特点,探索RA出现颈椎半脱位的危险因素.方法本研究采用回顾性临床分析方法,纳入68例有颈椎相关症状并行影像学检查的RA患者.根据影像学表现分为颈椎半脱位组和无脱位组,对比2组患者临床、实验室及影像学特点.采用t检验、Mann-Whitney U检验、x2检验及Person相关分析进行统计.结果纳入患者影像学证实为颈椎半脱位者占同期我院RA患者的11.6％ (39/335).最常见的症状为颈痛,占87％ (34/39),其次为四肢麻木,占9％(23/39).颈椎半脱位组CRP阳性率[89％ (24/27)]明显高于无脱位组[59％(16/27)] (x2=6.17,P＜0.01).影像学方面,RA颈椎半脱位患者常见表现形式为寰枢椎前脱位[95％(37/39)]、垂直脱位[18％(7/39)]和下段颈椎脱位[(5％(21/39)].颈椎半脱位组出现骨质破坏、椎管狭窄、脊髓受压比例明显高于无脱位组(x2=7.96,x2=6.12,x2=4.89,P＜0.05),而颈椎无脱位组更常出现骨质增生硬化(x2=6.21,P＜0.05).在颈椎半脱位组中,PADI与屈位片上的ADI具有相关性(r=-0.547,P=0.015).结论 RA合并颈椎半脱位并不少见,其形式主要为寰枢椎前脱位.影像学特点为骨质破坏、椎管狭窄和脊髓受压.
목적 료해RA경추반탈위적발생정황、림상、실험실화영상학특점,탐색RA출현경추반탈위적위험인소.방법 본연구채용회고성림상분석방법,납입68례유경추상관증상병행영상학검사적RA환자.근거영상학표현분위경추반탈위조화무탈위조,대비2조환자림상、실험실급영상학특점.채용t검험、Mann-Whitney U검험、x2검험급Person상관분석진행통계.결과 납입환자영상학증실위경추반탈위자점동기아원RA환자적11.6％ (39/335).최상견적증상위경통,점87％ (34/39),기차위사지마목,점9％(23/39).경추반탈위조CRP양성솔[89％ (24/27)]명현고우무탈위조[59％(16/27)] (x2=6.17,P＜0.01).영상학방면,RA경추반탈위환자상견표현형식위환추추전탈위[95％(37/39)]、수직탈위[18％(7/39)]화하단경추탈위[(5％(21/39)].경추반탈위조출현골질파배、추관협착、척수수압비례명현고우무탈위조(x2=7.96,x2=6.12,x2=4.89,P＜0.05),이경추무탈위조경상출현골질증생경화(x2=6.21,P＜0.05).재경추반탈위조중,PADI여굴위편상적ADI구유상관성(r=-0.547,P=0.015).결론 RA합병경추반탈위병불소견,기형식주요위환추추전탈위.영상학특점위골질파배、추관협착화척수수압.
Objective To investigate the clinical and radiographic features of rheumatoid arthritis (RA) patients with cervical subluxations.Methods The clinical, laboratory and imaging data of 68 RA patients who were hospitalized to our hospital because of cervical syndrome were retrospectively reviewed.The patients were divided into two groups depend based on whether cervical spine subluxations presented or not.Mann-Whitney U test, t test and Person correlation, x2 test were used for statistical analysis.Results This study confirmed the high frequency (11.6％, 39/335) of radiological cervical subluxations in RA patients.The nNeck pain was a common symptom, accounting for 87％ (34/39).Other symptoms included limb numbness 59％ (23/39).The rate of positive C-reactive protein (CRP) in the subluxation group was both significantly higher than that of the non-subluxation group [89％(24/27) vs 59％(16/27),x2=6.17, P＜0.01].Anterior atlantoaxial subluxation (AAS) was the most common form, accounting for 95％(37/39) of all cervical subluxations,followed by vertical subluxation (VS), accounting for 18％ (7/39).Subaxial subluxation (SAS) of the lower cervical vertebrae was less common (5.1％).The ratio of bone destruction, spinal stenosis, spinal cord compression in image findings of the subluxation group was significantly higher than that of the non-subluxation group (x2=7.96, x2=6.12, x2=4.89, P＜0.05).But more hyperostosis and osteosclerosis feature of the non-subluxation group could be observed more hyperostosis and osteosclerosis feature (x2=6.21, P＜0.05).PADI correlated with ADI (r=-0.588, P=0.015).Conclusion This study confirms the high frequency of radiological cervical involvement in patients with RA.AAS is the most common form of cervical involvement and may occur either independently or concomitantly with cranial settling and subaxial subluxation.