関節リウマチの頚椎手術例の生命予後と予後不良因子の検討

Survival and Negative Prognostic Factors of Rheumatoid Arthritis Patients who undergo Cervical Spine Surgery

　抄録：1991～2001年までに当科にて頚椎手術を施行したRA患者78例（男性20例，女性58例：追跡率88.6％）を，生存群と死亡群に分け，手術時年齢，RA発症時年齢，RA罹病期間，RA頚椎の病態，脊髄症の重症度の比較，死亡原因，性別，年代別，手術時のRA頚椎の病態および重症度，脊髄症の重症度別の死亡率を比較検討した．手術時平均年齢61.6歳，RA歴平均16.8年，RA発症平均年齢44.4歳，経過観察期間平均3.6年であった．追跡時，生存53例，死亡25例（術後平均生存期間2.5年）死亡時平均年齢66.5歳で，死因は感染症が最も多かった．生命予後不良因子は，男性，RA発症年齢が比較的高い例，短期間に頚髄病変が増悪する例，SASの重症例，RanawatⅢb群であり，予後には，頚髄障害の重症度の関与が高いと考えられる．手術による移動能力の獲得により生命予後が明らかに改善するため，手術の意義は高い．

　We reviewed the clinical data of 78 rheumatoid arthritis (RA) patients (20men and 58 women) who underwent cervical spine surgery in our department between 1991 and 2001 (follow-up rate：88.6％) and investigated mortality and causes of death. We divided the patients into two groups, a group that had died and a group that had survived and evaluated differences in sex, age at surgery,age at onset of RA, duration of RA, type of cervical subluxaion, and severity of myelopathy (Ranawat classification) between the two groups. The results revealed male predominance, older age at surgery and age at RA onset, shorter duration of RA, subaxial subluxation predominace, and severer myelopathy (Ranawat Ⅲb) in the group that had died. The severity of myelopathy appeared to be strongly associated with the life expectancy of RA patients who underwent cervical spine surgery, and improvement from Ranawat Ⅲb to Ranawat Ⅲa or less as a result of surgery predicted longer life.