黄正-类风湿关节炎颈椎不稳(英文).pptVIP

Surgery as a prophylactic procedure Recommend early surgical intervention （1） Prophylactic surgery is a valid option in an asymptomatic patient. （2） Operation for patients with myelopathy is recommended. Conclusions RACSI： Signi?cant morbidity and mortality. Myelopathic： The rate of longterm mortality increases and the chance of neurologic recovery decreases. Conclusions Recommend early and aggressive surgical intervention ： avoid cervical spine deterioration, preserve remaining function and prevent further neurologic injuries. Even nonambulant patients should not be discouraged from surgical intervention since this can be the only chance they have. Case1 Atlantoaxial arthrodesis Case1 Female, aged 68, RA, Neck pain and symptoms of cervical myelopathy. Case1 Case1 Case2 Case2 Case2 Case2 Thank you for attention Cervical spine instability in rheumatoid arthritis(RACSI) Spine Group Orthopedic Department Huang zheng Abbreviations CS 颈椎 AAS 寰枢椎脱位 CrS 颅底凹陷症 SAS 下颈椎脱位 AADI 寰齿前间隙 PADI 寰齿后间隙 CMA 延髓脊髓角 SSCD下椎管直径 Introduction 1、High incidence: 85% in the patients with RA CS is the most commonly involved segment , after hands and feet. 2、Severe sequelae: Neurologic de?cits even sudden death Introduction 3、Difficult to diagnosis： Asymptomatic Similar to peripheral diseases 4、Difficult to treatment: Poor conservative treatment The optimal timing for surgery Pathophysiology 1、 The same process that affects the peripheral joints in patients with RA also affects the neck. destroy 2、 pannus chronic synovitis ligaments, tendons, cartilage and bone RACSI Pathophysiology 3、 Patterns of instability： atlantoaxial subluxation (AAS) 65% cranial settling (CrS) 20% subaxial subluxation (SAS) 15-25% Pathophysiology AAS a4mm，b14mm a b Pathophysiology CrS a a4.5mm Pathophysiology a1+a211° b1+b23.5mm SAS Pathophysiology large range of motion 4、 UCS purely synovial joints Pathophysiol