Yaszemski M J, Shepler T R
Department of Orthopaedic Surgery, Wilford Hall USAF Medical Center, Texas.
Spine (Phila Pa 1976). 1990 Apr;15(4):338-41.
We have presented a case of death from AAS in a rheumatoid patient. We believe her cardiac arrest was caused by an acute myocardial infarction (MI) or dysrhythmia. We cannot determine whether the MI/dysrhythmia was itself a lethal event. The damage to her lower medulla and upper cervical cord, which most likely occurred at the time of her intubation, was a lethal injury. The presence of spinal cord ischemic changes and acute inflammatory cells within the cord indicate that the cervical spine injury occurred premortem. This patient had no neck pain, no neurologic symptoms or signs, and had AAS of 8 mm. Weissman suggests that 9 mm of AAS is the critical amount. The 1-mm subluxation difference here is probably not significant, because there is inherent error when measuring radiographs. We took into account her clinical and radiographic data, and decided to manage her C1-C2 articulation nonoperatively. Nevertheless, her atlanto-axial joint consisted of abnormal soft and hard tissue. This joint was satisfactory for her usual activities of daily living. The anteroposterior forces generated during ACLS intubation, which are unlikely to disrupt a normal atlanto-axial joint, were sufficient to subluxate her joint. This case demonstrates that it behooves us to maintain a high level of awareness for potential cervical spine problems in all rheumatoid arthritis patients.
我们报告了一例类风湿性关节炎患者因使用兴奋剂导致死亡的病例。我们认为她的心脏骤停是由急性心肌梗死（MI）或心律失常引起的。我们无法确定MI/心律失常本身是否是致命事件。她延髓下部和颈髓上部的损伤很可能发生在插管时，是致命伤。脊髓缺血性改变和脊髓内急性炎症细胞的存在表明颈椎损伤发生在死前。该患者没有颈部疼痛，没有神经症状或体征，寰枢关节间距为8毫米。魏斯曼认为9毫米的寰枢关节间距是临界值。这里1毫米的半脱位差异可能并不显著，因为在测量X线片时有固有误差。我们综合考虑了她的临床和影像学数据，决定对其C1-C2关节进行非手术治疗。然而，她的寰枢关节存在异常的软组织和硬组织。这个关节对于她日常的生活活动来说是足够的。在高级心血管生命支持（ACLS）插管过程中产生的前后向力，虽然不太可能破坏正常的寰枢关节，但足以使其关节半脱位。这个病例表明，我们有必要对所有类风湿性关节炎患者潜在的颈椎问题保持高度警惕。
