環軸関節穿刺・注射で軽快する急性頚部痛―Crowned Dens Syndrome

Acute Neck Pain Arising in the Atlantoaxial Joint. Crowned Dens Syndrome

　Crowned dens syndrome（CDS）と診断した症例に環軸関節穿刺を行い，痛みの原因が環軸関節に起因しているかを検証した．CDS 4例に環軸関節穿刺をした後，ゲンタシン^®または1％塩酸メピバカインを1ml注入した．Visual analogue scale（VAS）は穿刺前平均89mmが穿刺30分後48mm，翌日には40mmとなった．3例で穿刺液が吸引され，穿刺液中にピロリン酸カルシウム（CPPD）結晶を確認できた．CDSは環軸関節に生じた偽痛風発作であることが示唆された．

　We reviewed 4 cases of crowned dens syndrome (CDS) in which the patient complained of acute neck pain. We performed arthrocentesis of the atlantoaxial joint in all cases, and material was aspirated in 3 of them. Colcium pyrophosphate dihydrate (CPPD) crystals were demonstrated in all 3 cases. Two patients who were intra-articularly injected with a local anesthesic experienced immediate relief of their neck pain. We suggest that CDS is pseudogout of the atlantoaxial joint and that the neck pain of CDS originates in the atlantoaxial joint.