Retrodental Mass in Rheumatoid Arthritis
Retrodental Mass in Rheumatoid Arthritis
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DOI：
10.1097/bsd.0b013e3182621a05
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发表时间：
2013-04
影响因子：
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通讯作者：
I. Yonezawa;Takatoshi Okuda;J. Won;Junta Sakoda;D. Nakahara;H. Nojiri;Osamu Muto;Rei Momomura;K. Kaneko
中科院分区：
文献类型：
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作者：
I. Yonezawa;Takatoshi Okuda;J. Won;Junta Sakoda;D. Nakahara;H. Nojiri;Osamu Muto;Rei Momomura;K. Kaneko
研究设计：回顾性调查继发于类风湿性关节炎（RA）的牙后肿块。目的：提出类风湿关节炎（RA）牙后肿块的新分类，并探讨其吸收过程和手术方法。背景资料概述：继发于类风湿关节炎的牙后肿块长期以来被认为是血管翳的形成。众所周知，在寰枢节段稳定后，血管翳将消失或根本性减少。然而，过去的报告没有回答以下问题：是否有其他类型的肿块与血管翳的变性过程显著不同？经口前路减压术的必要性仍有争议。方法：回顾性分析11例RA患者的临床资料。他们接受后路融合术，寰枢椎半脱位不减压，枕颈融合术，寰椎椎板减压切除术，垂直半脱位。所有患者在手术前后均进行了神经学、放射学和磁共振成像（MRI）评估。术前及术后1个月行MRI检查，直至肿块消失或停止进一步缩小。结果：本研究确定了3个不同类型的类风湿性牙后肿块的MRI。1型表现为T2高信号和T1WI低信号或血管翳特有的模式。2型表现为T2加权MRI低信号或假瘤特有的形态。3型表现为T2加权像上高信号和低信号的混合或血管翳和假瘤的混合。所有1型和3型肿块在手术后1个月内消失。第二类的过程要慢几个月。在所有11例病例中，脊髓病术后均改善至症状出现前的状态。结论：本文将RA的牙后肿块分为三种类型：1型（血管翳），2型（假瘤），3型（混合型）。结论：对于继发于类风湿关节炎的寰枢椎半脱位的所有类型的牙后肿块，后路融合术不减压可改善脊髓病变。在与垂直半脱位相关的2型中，在可计算的收益和经口前路减压术的高风险之间进行平衡，作者倾向于选择枕颈融合联合寰椎减压椎板切除术。
Study Design: A retrospective investigation of the retrodental mass secondary to rheumatoid arthritis (RA). Objective: To propose a new classification of the retrodental mass in RA, and to evaluate their resorption processes and surgical procedures. Summary of Background Data: The retrodental mass secondary to RA has long been recognized as pannus formation. It is also known that pannus will disappear or radically reduce after stabilization of the atlantoaxial segment. The past reports, however, leave unanswered the following question; are there other types of mass with significantly different degeneration processes from the pannus? The need for anterior transoral decompression is still controversial. Methods: Eleven patients with retrodental masses in RA were retrospectively analyzed. They underwent posterior fusion without decompression for atlantoaxial subluxation and occipitocervical fusion with decompressive laminectomy of the atlas for vertical subluxation. All patients had neurological, radiologic, and magnetic resonance imaging (MRI) evaluations both before and after surgery. MRI study was performed preoperatively and at 1-month interval after surgery until the mass had disappeared or stopped further reduction. Results: This study identified 3 distinctive types in the rheumatoid retrodental mass on MRI. Type 1 displayed high intensity on T2 and low intensity on T1-weighted MRI or the pattern specific to pannus. Type 2 was identified with low intensity on T2-weighted MRI or pattern specific to pseudotumor. Type 3 displayed a combination of high and low intensity on T2-weighted images or indication that the mass was the mixture of pannus and pseudotumor. All the masses of types 1 and 3 disappeared within 1 month of surgery. The process in type 2 was found a few months slower. In all 11 cases, myelopathy improved postoperatively to the status before the emergence of the symptom. Conclusions: This article recognized 3 distinctive types of the retrodental mass in RA; type 1 (pannus), type 2 (pseudotumor), type 3 (mixed). It further concludes in all types of the retrodental mass associated with atlantoaxial subluxation secondary to RA, posterior fusion without decompression can achieve improvement of the myelopathy. In type 2 associated with vertical subluxation, on balance between calculable benefits and high risks of anterior transoral decompression, the authors prefer to opt for occipitocervical fusion with decompressive laminectomy of the atlas.