関節リウマチ頚椎手術の全国調査

Results of Epidemiologic Survey on the Surgical Treatment of Cervical Lesions in Rheumatoid Arthritis

　関節リウマチ（RA）頚椎手術の実情を把握するため，2001年の手術例に関し全国アンケート調査を行った．74施設で234名236件の手術が実施されていた．主な結果は，年間症例数3件以下の施設が実施施設数の74.3％を占めたこと，主な手術方法は後頭骨頚（胸）椎固定術と環軸椎固定術であったこと，手術方法により術前神経症状重症度に相違がみられたこと，自施設のRA治療例より他施設からの紹介例への手術数が上回ったことである．得られたRA頚椎手術に関する疫学データは，RA治療医に対する情報提供となる．

　A nationwide epidemiologic survey of 313 institutions in Japan was conducted to determine the current status of surgical treatment of rheumatoid cervical spine. Replies were received from 196 institutions (62.1％), and data related to 234 cases of rheumatoid arthritis in which surgery of the cervical spine had been performed in 2001 were obtained from 74 institutions. The annual number of surgical cases was≦3 in the majority (74.3％) of the 74 institution. The surgical procedure was occipito-cervical (or occipito-cervicothoracic) fusion in 96 cases, atlanto-axial fusion in 102 cases, and others in 38 cases. Preoperative neurological class as defined by Ranawat et al. wasⅠ in 30 cases, Ⅱ in 43, Ⅲa in 55, Ⅲb in 30, and unknown in 76. The distribution of cases according to preoperative neurological class differed according to the surgical procedure. The main care provider for the rheumatoid arthritis patients was an orthopedic surgeon in 111 cases (47.4％) and internist in 71 cases (30.3％). These epidemiologic data will be useful to medical personnel engaged in the management of rheumatoid arthritis.