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寰樞椎結核

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寰樞椎結核是一種罕見的脊柱結核,約佔脊柱結核的0.3%~1%[1]。脊柱結核首先會感染滑膜、側塊或椎體松質骨,進而緩慢地侵犯椎體之間的韌帶,令寰樞椎變得不穩定[2]。因為寰樞椎結核缺乏特異性的早期表現,診斷較為困難,甚至會誤診,誤診率高達50%~71%[3]

Lifeso將寰樞椎結核分成三個階段。第一階段沒有發現骨質破壞或移位的證據,第二階段出現韌帶破壞、寰椎樞椎上的前移位和最小的骨破壞,同時還具有或不具有齒狀突的近端移位,而第三階段則有明顯的骨質破壞及完全閉塞的寰椎前弓[4]

臨床症狀

寰樞椎結核的早期臨床症狀是輕微和非特徵性的,主要特徵是頸部疼痛、頸部活動受限[5],然而頸椎病和強直性脊柱炎等也有相似的臨床症狀,可以導致漏診或誤診。有研究指出其他相關的特徵包括獲得性免疫缺陷綜合徵、夜間體溫升高和體重減輕[6]

寰樞椎結核非特異性症狀的平均持續時間為5至6個月。隨著病情的發展,慢慢會出現四肢癱瘓延髓功能障礙、呼吸危象,甚至可能會猝死,即斜頸和進展性頸髓受壓迫症狀[7]

治療

目前在治療寰樞椎結核時並沒有明確的指導方針,從抗結核藥物等保守治療到手術治療的觀點各不相同[8],然而寰樞椎結核治療方案的主要決定標準就是患者的神經受損、骨質破壞和脊髓壓迫的程度,以及寰樞椎脫位和對抗結核藥物的敏感性[9]

參考資料

  1. ^ Ramamurthi, B. Management of tuberculomas of the craniovertebral junction.. British journal of neurosurgery. 2000-12, 14 (6): 600 [2020-04-06]. PMID 11272052. doi:10.1080/02688690050206873. (原始內容存檔於2020-04-06). 
  2. ^ Lee, DK; Cho, KT; Im, SH; Hong, SK. Craniovertebral junction tuberculosis with atlantoaxial dislocation : a case report and review of the literature.. Journal of Korean Neurosurgical Society. 2007-11, 42 (5): 406–9 [2020-04-06]. PMID 19096579. doi:10.3340/jkns.2007.42.5.406. (原始內容存檔於2020-04-06). 
  3. ^ Mandavia, R; Fox, R; Meir, A. Atlantoaxial TB with paralysis: posterior-only cervical approach with good results.. JRSM open. 2017-06, 8 (6): 2054270417697866 [2020-04-06]. PMID 28620504. doi:10.1177/2054270417697866. (原始內容存檔於2020-04-06). 
  4. ^ Lifeso, R. Atlanto-axial tuberculosis in adults.. The Journal of bone and joint surgery. British volume. 1987-03, 69 (2): 183–7 [2020-04-06]. PMID 3818746. (原始內容存檔於2020-04-06). 
  5. ^ Goel, A; Sharma, P; Dange, N; Kulkarni, AG. Techniques in the treatment of craniovertebral instability.. Neurology India. 2005-12, 53 (4): 525–33 [2020-04-06]. PMID 16565547. doi:10.4103/0028-3886.22625. (原始內容存檔於2020-04-06). 
  6. ^ Puraviappan, P; Tang, IP; Yong, DJ; Prepageran, N; Carrau, RL; Kassam, AB. Endoscopic, endonasal decompression of spinal stenosis with myelopathy secondary to cranio-vertebral tuberculosis: two cases.. The Journal of laryngology and otology. 2010-07, 124 (7): 816–9 [2020-04-06]. PMID 20003599. doi:10.1017/S0022215109992271. (原始內容存檔於2020-04-06) (英語). 
  7. ^ Gupta, SK; Mohindra, S; Sharma, BS; Gupta, R; Chhabra, R; Mukherjee, KK; Tewari, MK; Pathak, A; Khandelwal, N; Suresh, NM; Khosla, VK. Tuberculosis of the craniovertebral junction: is surgery necessary?. Neurosurgery. 2006-06, 58 (6): 1144–50; discussion 1144–50 [2020-04-06]. PMID 16723893. doi:10.1227/01.NEU.0000215950.85745.33. (原始內容存檔於2020-04-06). 
  8. ^ Attia, M; Harnof, S; Knoller, N; Shacked, I; Zibly, Z; Bedrin, L; Regev-Yochay, G. Cervical Pott's disease presenting as a retropharyngeal abscess.. The Israel Medical Association journal : IMAJ. 2004-07, 6 (7): 438–9 [2020-04-06]. PMID 15274540. (原始內容存檔於2020-04-06). 
  9. ^ Moon, MS; Moon, JL; Kim, SS; Moon, YW. Treatment of tuberculosis of the cervical spine: operative versus nonoperative.. Clinical orthopaedics and related research. 2007-07, 460: 67–77 [2020-04-06]. PMID 17414165. doi:10.1097/BLO.0b013e31805470ba. (原始內容存檔於2020-04-06).