寰樞椎結核

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、寰椎在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]。

臨床症狀编辑

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]。

治療编辑

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]。

參考資料编辑

^ 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. （原始内容存档于2020-04-06）.
^ 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. （原始内容存档于2020-04-06）.
^ 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. （原始内容存档于2020-04-06）.
^ 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. （原始内容存档于2020-04-06）.
^ 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. （原始内容存档于2020-04-06）.
^ 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. （原始内容存档于2020-04-06）（英语）.
^ 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. （原始内容存档于2020-04-06）.
^ 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. （原始内容存档于2020-04-06）.
^ 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. （原始内容存档于2020-04-06）.

[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. （原始内容存档于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. （原始内容存档于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. （原始内容存档于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. （原始内容存档于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. （原始内容存档于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. （原始内容存档于2020-04-06）（英语）.

[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. （原始内容存档于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. （原始内容存档于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. （原始内容存档于2020-04-06）.

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