関節リウマチにおける上位頚椎病変に対する後頭骨頚椎間固定術の治療成績

Occipitocervical Fusion for an Upper Cervical Rheumatoid Arthritis Lesion

　関節リウマチにおける上位頚椎病変に対して後頭骨頚椎間固定術を行った44例（手術時平均年齢65歳）の治療成績を調査した．術後累積生存率は術後5年で79.8％，死亡時平均年齢は71歳であった．術後全例に痛み・脊髄症の改善を認めた．骨癒合率は91％で，偽関節例の1例で脊髄症が増悪し再手術を要した．術後中下位頚椎病変の発生による再手術率は12.5％で，特に後弯位固定例の治療成績が不良だった．本法施行例の生命予後・機能予後は良好で，脊髄症や保存的治療に抵抗性の後頭部痛に対しては積極的に手術を行ってよい．

　We evaluated 44 patients with rheumatoid arthritis (RA) who underwent occipitocervical fusion for an upper cervical lesion at Nishitaga National Hospital. The average duration of the RA was 16 years, and mean age at the time of surgery was 65 years. The survival rate 5 years postoperatively was 79.8％. The mean age at death was 71 years. The preoperative occipital pain was reduced and the myelopathy improved in every patient. The bone fusion rate was 91％. One patient required additional surgery because of pseudarthrosis, and four patients (12.5％) required additional surgery because of the development of a subaxial lesion during postoperative follow-up. The O-C2 angles were measured in all patients, and two patients with negative O-C2 angles developed retrolisthesis of the mid-cervical spine. Occipitocervical fusion for upper cervical lesions in RA is useful for reducing the occipital pain and improving the myelopathy and improving prognosis.