颈椎类风湿性关节炎X线诊断

颈椎类风湿性关节炎(Rheumoiumarthritis)是一种结缔组织疾病,人们通常熟知发生在四肢小关节。有关教科书和文献报导此病亦是以手指近位关节、尤其是第五指间关节好发为重要。但文献很少报导颈椎类风湿性关节炎发病率和病变的X线特征性改变。本组类风湿科从1976年～1987年共收集501例颈椎类风湿性关节炎均合并手腕关节发病。其中多先发病于手、腕关节,少数颈椎X线片改变先行于手、腕部位,病例均按美国风湿病协会(A、R、A)诊断标准⁽¹⁾。全部病例是在摄双手、腕X线片同时摄取颈椎正侧位X线片。本文现将颈椎类风湿性关节炎(RA)与强直性脊柱炎在X线片上表现相比较。以便于参考。     

颈椎类风湿关节炎的临床特点及诊疗进展

 类风湿关节炎（rheumatoid arthritis,RA）是一种病因不明的慢性全身性自身免疫性疾病,多见于中年女性。主要表现为对称性、慢性、进行性多关节炎。关节滑膜的慢性炎症、增生,形成血管翳,侵犯关节软骨、软骨下骨、韧带和肌腱等,造成关节软骨、骨和关节囊破坏,最终导致关节畸形和功能丧失［1］。一般来说,RA可以出现在任何关节,掌指关节、近端指间关节、跖趾关节和腕关节往往是最初也是最常受累部位［2］。当病变发展到一定程度时,也可累及其他关节,例如脊柱。尽管胸腰椎也会受累,但颈椎是RA在脊柱中最好发的部位［3］。文献报道9%~88%的RA患者会累及颈椎,甚至有学者认为颈椎是仅次于手和足的RA好发部位,在所有RA患者中出现颈椎RA的比例超过50%,而RA病程进展至颈椎受累通常会经过平均十年的时间［4-5］。     

上颈椎类风湿性关节炎的研究进展

类风湿性关节炎(rheumatoid arthritis,RA)是一种以全身多关节滑膜炎为主要病理特征的自身免疫性疾病,人群患病率为0.5%~1.0%。RA常累及手足等外周关节,其次是颈椎,寰枢及寰枕关节、齿状突及维持上颈椎稳定性的重要韧带受侵蚀破坏后,可致寰枢椎脱位、颅底凹陷,脊髓神经受压时可表现为相应的神经损害症状。若不积极治疗,神经功能进一步损害,将影响生活质量甚至死亡。因此,充分认知、尽早诊断治疗是获得良好预后的关键。但RA是全身系统性疾病,且患者长期服用抗风湿药物等,围手术期风险较常规上颈椎手术大,治疗难度增加。笔者就上颈椎RA的病理机制、流行病学特点、临床表现、影像学特征、治疗研究进展和预后综述如下。     

颈椎类风湿关节炎的诊疗进展

类风湿关节炎（rheumatoid arthritis,RA）是一种以滑膜关节病变为主要表现的慢性自身免疫性疾病,构成关节的各种组织,如滑膜、软骨、韧带、肌腱以及骨骼均可受累。手足病变最为常见,多表现为对称性多关节炎;颈椎亦常受累,表现为各种颈椎不稳,可导致延髓、脊髓或神经根受压而表现相应的神经功能障碍。颈椎RA患者常合并周围关节的畸形、僵直或活动受限,体格检查不能准确评估神经功能状态,患者一旦出现明显的神经症状,颈椎不稳已进展较为严重。因此,应加深对颈椎RA的认识,有助于疾病的及时诊治。本文将就颈椎RA的诊断和手术治疗进展作一综述。     

颈椎类风湿关节炎诊治进展

<正>类风湿关节炎(Rheumatoid Arthritis,RA)是以关节滑膜炎为主要表现的慢性自身免疫性疾病,颈椎是RA第2个最容易侵犯的区域[1],初期主要表现为滑膜炎侵犯颈椎,引起关节囊、韧带结构破坏及颈椎关节不稳,后期出现严重的力学上的退变,并可能导致脊髓、神经受压,引起一系列并发症。有10%~85%的RA患者有颈痛及影像学上颈椎不稳的表现,10%~     

颈椎前路术后两次食管瘘1例报道

<正>食管瘘(esophageal perforation)是颈椎前路手术一种少见的严重并发症,其发生率为0.3%~4%~([1])。食管瘘可导致吞咽困难和疼痛、肺炎、发热、胸痛、呼吸困难、消瘦、甚至致命等,但也有无症状的报道。目前已有大量文献报道食管瘘的病例~([1]),也有1例多发性食管瘘的报道~([2]),本院收治1例颈椎前路术     

益肾清利法治疗肾性贫血的Meta分析

正慢性肾脏病(chronic kidney disease,CKD)是一项全球性的公共卫生挑战,发病率约为10%,而中国成人慢性肾病患病率为10.8%,约1.2亿例~([1,2])。肾性贫血(renal anemia,RA)是慢性肾脏病的主要并发症之一,与增加的死亡风险相关~([3,4])。一项比较慢性病贫血程度和死亡风险相关性的研究表明,贫血较轻组(84±45) g/L的患者较贫血严重组(59±47) g/L患者的心衰发生率和死亡率更低~([5])。如果对RA患者进行有效地治疗,可降低输血率并改善临床预后~([6])。     

颈椎后纵韧带骨化症的外科治疗进展

正颈椎后纵韧带骨化症(OPLL)是一种好发于亚洲人群的颈椎退行性疾病,由于颈椎的后纵韧带发生异位骨化,从而继发椎管狭窄、脊髓和神经根受压,导致肢体的运动和感觉功能障碍~([1])。OPLL为亚洲人群颈脊髓受压的常见病因,首先由日本学者Tsukimato于1960年报道~([2])。Fujimori等~([3])通过对1 500例日本病例的CT扫描分析发现,颈椎OPLL的发生率可达6.3%(男性8.3%,女性3.4%)。OPLL根据骨化物形态的不同可分为局灶型、节段     

强直性脊柱炎颈椎隐匿不全骨折非手术治疗2例报告

正隐匿骨折(OF)指常规X线检查不能发现或疑似但不能明确诊断,需其他特殊检查才能发现的骨折~([1])。强直性脊柱炎(AS)患者脊椎强直后力学特性发生变化,轻微暴力就可能导致其骨折~([2-3])。本院曾收治2例AS并颈椎隐匿不全骨折患者,确诊后给予非手术治疗,未进展到完全骨折。现将诊疗过程报告如下。     

颈椎后凸畸形动物模型的研究进展

<正>颈椎后凸畸形的形成与局部的颈椎退变、创伤、肿瘤、发育畸形以及医源性(颈椎前后路手术)因素有关,系统性疾病如强直性脊柱炎、类风湿关节炎也会导致本病的发生~([1])。其临床表现因原发疾病不同而表现各异,主要为颈痛、肩痛和神经压迫症状,严重的出现chin-on-chest(下     

Increases in BMD correlate with improvements in bone microarchitecture with teriparatide treatment in postmenopausal women with osteoporosis.

Increases in BMD are correlated with improvements in 2D and 3D trabecular microarchitecture indices with teriparatide treatment. Therefore, improvements in trabecular bone microarchitecture may be one of the mechanisms to explain how BMD increases improve bone strength during teriparatide treatment. INTRODUCTION: Bone strength is determined by BMD and other elements of bone quality, including bone microarchitecture. Teriparatide treatment increases BMD and improves both cortical and trabecular bone microarchitecture. Increases in lumbar spine (LS) BMD account for approximately 30-41% of the vertebral fracture risk reduction with teriparatide treatment. The relationship between increases in BMD and improvements in cortical and trabecular microarchitecture has not yet been studied. MATERIALS AND METHODS: The relationship between increases in BMD and improvements in cortical and trabecular microarchitecture after teriparatide treatment was assessed using data from a subset of patients who had areal BMD measurements and structural parameters from transiliac bone biopsies in the Fracture Prevention Trial. 2D histomorphometric and 3D microCT parameters were measured at baseline and 12 (n = 21) or 22 (n = 36) mo. LS BMD was assessed at baseline and 12 and 18 mo, and femoral neck (FN) BMD was measured at baseline and 12 mo. Pearson correlation was performed to assess the relationship between actual changes in BMD and actual changes in microarchitectural parameters. RESULTS: Changes in LS BMD at 12 mo were significantly correlated with improvements in trabecular bone structure at 22 mo: 2D bone volume (r = 0.45, p = 0.02), 2D mean wall thickness (r = 0.41, p = 0.03), 3D bone volume (r = 0.48, p = 0.006), 3D trabecular thickness (r = 0.44, p = 0.01), 3D trabecular separation (r = -0.37, p = 0.04), 3D structural model index (r = -0.54, p = 0.001), and 3D connectivity density (r = 0.41, p = 0.02). Changes in LS BMD at 18 mo had similar correlations with improvements in bone structure at 22 mo. Changes in FN BMD at 12 mo were significantly correlated with changes in 2D mean wall thickness (r = 0.56, p = 0.002), 3D bone volume (r = 0.51, p = 0.004), 3D trabecular thickness (r = 0.44, p = 0.01), 3D trabecular separation (r = -0.46, p = 0.01), and 3D structural model index (r = -0.55, p = 0.001). CONCLUSIONS: Increases in BMD are correlated with improvements in trabecular microarchitecture in iliac crest of patients with teriparatide treatment. Therefore, improvements in trabecular bone microarchitecture may be one of the mechanisms to explain how BMD increases improve bone strength during teriparatide treatment.     

Pyloroplasty in association with Nissen fundoplication in children with neurologic disorders

Previous studies have suggested that delayed gastric emptying occurs in severely mentally retarded patients with gastroesophageal reflux. Based on this data, pyloroplasty was employed in such patients. A retrospective analysis of 99 consecutive patients who underwent primary fundoplication for GER was performed. Gastric emptying, as measured by successful removal of the nasogastric tube or elevation of the gastrostomy tube, was studied. Children with neurologic disorders had no clinically significant difference in gastric emptying after fundoplication (3.31 days) when compared with neurologically normal patients (2.21 days). When added to Nissen fundoplication, pyloroplasty did not hasten the return of gastrointestinal function in the severely impaired patients (4.91 days). A prospective study employing gastric isotope bolus feedings before and after Nissen fundoplication will determine if pyloroplasty improves gastric emptying when used in conjunction with Nissen fundoplication for patients with severe neurologic disorders.     

Bradycardia with sevoflurane in siblings with Branchio-oto-renal syndrome

Branchio-oto-renal syndrome (BOR, Melnick-Fraser syndrome, MIM#113650) refers to a rare autosomal dominant disorder characterized by branchial cysts or fistulas, hearing loss, external ear malformation, preauricular pits and renal abnormalities. The authors present three episodes of significant bradycardia in two siblings diagnosed with BOR syndrome during the sevoflurane general anesthesia. There is no published experience of anesthesia with this syndrome. Bradycardia occurred variously at induction, maintenance and immediately prior to emergence and required surgical stimulation, atropine, or epinephrine to treat. We seek to raise awareness of the potential for bradycardia during the procedures in patients with this syndrome requiring volatile anesthesia, especially sevoflurane.     

Chemotherapy in patients with teratoma with malignant transformation

OBJECTIVE: Germ-cell tumours (GCTs) with a non-GCT malignant component are a unique and rare phenomenon called teratoma with malignant transformation (TMT). The only published series of patients with TMT treated with chemotherapy comprised 10 patients. We report here our experience in treating 14 patients with TMT. PATIENTS AND METHODS: Sarcoma was identified in 10 of 14 patients, with rhabdomyosarcoma ranking first (n=4). Other histological types included adenocarcinoma (n=3) and bronchoalveolar carcinoma (n=1). Immunohistochemistry was performed to help in identifying the malignant non-GCT component. RESULTS: Primary treatment consisted of surgery alone in 4 patients. The remaining 10 patients received first-line cisplatin-based chemotherapy with resection of residual masses (n=5): 4 patients had a complete response and 5 had a partial response. Overall, 9 patients developed a relapse with a median time of 84 mo (range: 6-168). At relapse, 8 patients received a chemotherapy regimen directed to the non-GCT component. Four of these patients achieved a partial response. With a median follow-up of 59 mo (range: 3-180), 4 of 14 patients are alive, including 3 who are disease-free. CONCLUSION: To our knowledge, this is by far the largest reported European series of chemotherapy in TMT. Although TMT has a poor prognosis compared to GCT, its management may be improved by adapted chemotherapy associated with surgical resection of residual masses.     

Atherosclerosis in patients with analgesic nephropathy treated with haemodialysis

SUMMARY: Accelerated atherosclerosis was reported to be associated with chronic analgesic consumption, but most studies were retrospective, and individual findings have almost never been controlled with regard to other atherosclerotic risk factors. Ten haemodialysis patients with analgesic nephropathy (group I) and 19 haemodialysis patients where renal failure was not caused by analgesic nephropathy (group II) were included in the study. All patients were female without diabetes. Using B-mode ultrasonography, we compared intima-media thickness (IMT) in the carotid arteries and plaque occurrence, and their thickness in group I with that in group II. the possible differences in atherosclerotic risk factors in both groups were also investigated. In group I, the average age was 60.2 years, and the average dialysis treatment was 55.7 months. In group II, the average age was 54.6 years, and the average duration of dialysis treatment was 50.4 months. We found no statistically significant difference in the age and duration of dialysis treatment between groups I and II. the IMT values of the carotid arteries (0.97 vs 0.78 mm; P = 0.027) were significantly higher in group I. More patients had plaques in group I (90 vs 57.9%), and the number of plaques ( P = 0.037) and their thickness ( P = 0.043) were significantly higher in this group. There was no statistically significant difference in the atherosclerotic risk factors between groups I and II. the results indicate that patients with analgesic nephropathy treated with haemodialysis showed advanced atherosclerosis compared with other haemodialysis patients, despite no difference being found in the atherosclerotic risk factors between these patients.