Mathews J A
Department of Rheumatology, St Thomas' Hospital, London, UK.
QJM. 1998 Oct;91(10):691-700. doi: 10.1093/qjmed/91.10.691.
Four patients are described with destructive rheumatoid arthritis of the cervical spine and neurogenic wasting of forearm and hand muscles. The pathological connection is not immediately obvious, but a relationship between these two observations is described here with clinical, radiological, electrophysiological and necropsy findings. Compression of the anterior spinal artery at upper and mid-cervical levels is demonstrated to be the likely cause of changes lower in the spinal cord. These are shown to be due to the resulting ischaemia of the anterior part of the lower cervical spinal cord, with degeneration of the neurones innervating the forearm and hand muscles. These findings favour external compression of the anterior spinal artery leading to ischaemia in a watershed area as the likeliest explanation for this otherwise inappropriate and bizarre phenomenon.
本文描述了4例患有颈椎破坏性类风湿关节炎以及前臂和手部肌肉神经源性萎缩的患者。病理联系并非立竿见影，但此处通过临床、放射学、电生理和尸检结果描述了这两种表现之间的关系。已证实颈上段和中段水平的脊髓前动脉受压可能是脊髓下段发生改变的原因。这些改变被证明是由于下颈段脊髓前部缺血，导致支配前臂和手部肌肉的神经元变性所致。这些发现支持脊髓前动脉外部受压导致分水岭区缺血，这是对这种原本不恰当且奇怪现象最有可能的解释。
