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.
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.