寰枢椎结核是一种罕见的脊柱结核,约占脊柱结核的0.3%~1%[1]。脊柱结核首先会感染滑膜、侧块或椎体松质骨,进而缓慢地侵犯椎体之间的韧带,令寰枢椎变得不稳定[2]。因为寰枢椎结核缺乏特异性的早期表现,诊断较为困难,甚至会误诊,误诊率高达50%~71%[3]

Lifeso将寰枢椎结核分成三个阶段。第一阶段没有发现骨质破坏或移位的证据,第二阶段出现韧带破坏、寰椎枢椎上的前移位和最小的骨破坏,同时还具有或不具有齿状突的近端移位,而第三阶段则有明显的骨质破坏及完全闭塞的寰椎前弓[4]

临床症状

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寰枢椎结核的早期临床症状是轻微和非特征性的,主要特征是颈部疼痛、颈部活动受限[5],然而颈椎病和强直性脊柱炎等也有相似的临床症状,可以导致漏诊或误诊。有研究指出其他相关的特征包括获得性免疫缺陷综合征、夜间体温升高和体重减轻[6]

寰枢椎结核非特异性症状的平均持续时间为5至6个月。随着病情的发展,慢慢会出现四肢瘫痪延髓功能障碍、呼吸危象,甚至可能会猝死,即斜颈和进展性颈髓受压迫症状[7]

治疗

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目前在治疗寰枢椎结核时并没有明确的指导方针,从抗结核药物等保守治疗到手术治疗的观点各不相同[8],然而寰枢椎结核治疗方案的主要决定标准就是患者的神经受损、骨质破坏和脊髓压迫的程度,以及寰枢椎脱位和对抗结核药物的敏感性[9]

参考资料

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  1. ^ Ramamurthi, B. Management of tuberculomas of the craniovertebral junction.. British journal of neurosurgery. 2000-12, 14 (6): 600 [2020-04-06]. PMID 11272052. doi:10.1080/02688690050206873. (原始内容存档于2020-04-06). 
  2. ^ Lee, DK; Cho, KT; Im, SH; Hong, SK. Craniovertebral junction tuberculosis with atlantoaxial dislocation : a case report and review of the literature.. Journal of Korean Neurosurgical Society. 2007-11, 42 (5): 406–9 [2020-04-06]. PMID 19096579. doi:10.3340/jkns.2007.42.5.406. (原始内容存档于2020-04-06). 
  3. ^ Mandavia, R; Fox, R; Meir, A. Atlantoaxial TB with paralysis: posterior-only cervical approach with good results.. JRSM open. 2017-06, 8 (6): 2054270417697866 [2020-04-06]. PMID 28620504. doi:10.1177/2054270417697866. (原始内容存档于2020-04-06). 
  4. ^ Lifeso, R. Atlanto-axial tuberculosis in adults.. The Journal of bone and joint surgery. British volume. 1987-03, 69 (2): 183–7 [2020-04-06]. PMID 3818746. (原始内容存档于2020-04-06). 
  5. ^ Goel, A; Sharma, P; Dange, N; Kulkarni, AG. Techniques in the treatment of craniovertebral instability.. Neurology India. 2005-12, 53 (4): 525–33 [2020-04-06]. PMID 16565547. doi:10.4103/0028-3886.22625. (原始内容存档于2020-04-06). 
  6. ^ Puraviappan, P; Tang, IP; Yong, DJ; Prepageran, N; Carrau, RL; Kassam, AB. Endoscopic, endonasal decompression of spinal stenosis with myelopathy secondary to cranio-vertebral tuberculosis: two cases.. The Journal of laryngology and otology. 2010-07, 124 (7): 816–9 [2020-04-06]. PMID 20003599. doi:10.1017/S0022215109992271. (原始内容存档于2020-04-06) (英语). 
  7. ^ Gupta, SK; Mohindra, S; Sharma, BS; Gupta, R; Chhabra, R; Mukherjee, KK; Tewari, MK; Pathak, A; Khandelwal, N; Suresh, NM; Khosla, VK. Tuberculosis of the craniovertebral junction: is surgery necessary?. Neurosurgery. 2006-06, 58 (6): 1144–50; discussion 1144–50 [2020-04-06]. PMID 16723893. doi:10.1227/01.NEU.0000215950.85745.33. (原始内容存档于2020-04-06). 
  8. ^ Attia, M; Harnof, S; Knoller, N; Shacked, I; Zibly, Z; Bedrin, L; Regev-Yochay, G. Cervical Pott's disease presenting as a retropharyngeal abscess.. The Israel Medical Association journal : IMAJ. 2004-07, 6 (7): 438–9 [2020-04-06]. PMID 15274540. (原始内容存档于2020-04-06). 
  9. ^ Moon, MS; Moon, JL; Kim, SS; Moon, YW. Treatment of tuberculosis of the cervical spine: operative versus nonoperative.. Clinical orthopaedics and related research. 2007-07, 460: 67–77 [2020-04-06]. PMID 17414165. doi:10.1097/BLO.0b013e31805470ba. (原始内容存档于2020-04-06).