炎性关节炎颈椎受累的临床表现

摘要（美国）：风湿病患者颈椎受累比较常见，究其原因一方面是风湿病本身导致，另一方面是因为年龄相关的退行性病变所致。加强对于风湿病颈椎受累的临床表现及其带来的风险方面的认识将会帮助我们早期识别并进一步给予合适的干预措施。例如，类风湿关节炎患者经常会出现颈椎不稳的表现，如果不给予治疗，往往会导致神经功能的损伤。生物制剂在减缓骨骼破坏及治疗类风湿关节炎方面是有效的，并且生物制剂的治疗方案通常也是足够了。但仍然推荐伴有神经功能损伤的类风湿关节炎患者尽早接受手术治疗，因为保守治疗对于这一类患者的效果往往不佳。手术治疗的首要目标就是保持颈椎的稳定性。对于强直性脊柱炎患者来说，手术需要解决的主要问题是修复骨折或者矫正严重的驼背畸形。了解每一种疾病状态下特定的颈椎受累后的临床表现和自然病史，将会指导我们采取合适的干预措施，严格把握手术时机，以期最大程度改善患者的预后，同时减少并发症的发生。

附原文：The cervical spine can frequently become involved in patients with rheumatologic disorders, as a result of either the rheumatologic disease itself or age-associated degenerative processes that can also occur in the rest of the population. Awareness of the increased risk of cervical spine manifestations in patients with rheumatologic disorders enables early recognition and initiation of the appropriate treatment regimen. For example, patients with rheumatoid arthritis (RA) often have spinal instability which, if left untreated, can lead to neurological deficits. Biologic agents are effective in slowing the progression of the skeletal abnormality as well as for treating the RA, and this approach is often sufficient. However, early surgical intervention is recommended for patients with RA who develop neurologic deficits, as conservative approaches have limited effectiveness in this group. Spinal stability should be the primary surgical objective. For patients with ankylosing spondylitis, cervical spine surgery might be required either for fracture repair or to correct severe kyphosis. Understanding each condition’s specific cervical spine manifestation and its natural history can help to clarify the appropriate indications for and timing of surgery to maximize patients’ outcomes and limit complications.

引自： Thomas D. Cha and Howard S. An Cervical spine manifestations in patients with inflammatory arthritides. Nat. Rev. Rheumatol. 9, 423–432 (2013); published online 26 March 2013; doi:10.1038/nrrheum.2013.40

Cervical spine manifestations in patients.pdf(1.03 MB)