環軸関節に起因する急性頚部痛

Acute Neck Pain Caused by Arthritis of Atlanto-axial Joint

　2004年3月から2008年3月に受診した急性頚部痛27例に環軸関節穿刺と抗生剤あるいは局所麻酔剤の環軸関節内注射を行った．関節液が採取されれば顕微鏡検査を行った．対象は27例で平均75.9歳だった．CTでは3例に石灰化がなく，22例で横靱帯内に石灰化を認め，2例でC2の椎体前方に石灰化を認めた．VASスコアは，穿刺前平均81.9mmが穿刺30分後には平均35.6mmと軽快した(p＜0.001)．16例で関節液を採取でき，10例でcalcium pryophosphate dihydrate(CPPD)結晶が認められた．高齢者の急性頚部痛の一因として環軸関節炎による可能性が示唆された．

　We reviewed 27 cases in which the patient complained of acute neck pain.　We had performed arthrocentesis of the atlanto-axial joint in every case.　An aspirate was obtained in 16 of the cases, and calcium pryophosphate dihydrate (CPPD) crystals were demonstrated in 10 of them.　The patients' scores on the visual analogue scale decreased 30 minutes after aspiration of the crystals (p＜0.001).　CT demonstrated calcification of the transverse ligament in 22 cases, calcification anterior to the body of C2 in 2 cases, and no calcification in 3 cases.　The results in these patients suggest that acute neck pain in some elderly patients is related to arthritis of the atlanto-axial joint.