Breedveld F C, Algra P R, Vielvoye C J, Cats A
Arthritis Rheum. 1987 Jun;30(6):624-9. doi: 10.1002/art.1780300604.
We used magnetic resonance imaging (MRI) to examine 21 patients with rheumatoid arthritis and vertebral subluxations of the cervical spine, in whom neurologic symptoms and signs indicated spinal cord compression. Based on neurologic signs, the patients were assigned to 1 of 3 classes: class I, no objective signs of cervical myelopathy (9 patients); class II, only 1 objective sign of cervical myelopathy (4 patients); or class III, 2 or more objective signs of cervical myelopathy (8 patients). Atlantoaxial subluxation (20 patients) and subluxations below C2 (6 patients) were detected equally well by MRI and radiography. MRI revealed physical distortion of the spinal cord in all class III patients with compressive myelopathy. This distortion was found less frequently in class II and class I patients (3 patients), and the difference was statistically significant (P less than 0.005, class III versus class I and class II). No correlation was found between the vertebral dislocation (measured in millimeters) on plain radiographs and the presence of cord distortion on MRI. Myelography in class III patients showed that passage of contrast medium was blocked at the same level as the cord distortion seen on MRI. These findings suggest that MRI can serve as a useful, noninvasive procedure in the diagnosis and management of rheumatoid arthritis patients in whom compressive cervical myelopathy is suspected.
我们采用磁共振成像（MRI）对21例患有类风湿性关节炎且伴有颈椎半脱位、并有神经症状和体征提示脊髓受压的患者进行了检查。根据神经体征，将患者分为3组中的1组：I组，无颈髓病的客观体征（9例患者）；II组，仅有1项颈髓病的客观体征（4例患者）；或III组，有2项或更多颈髓病的客观体征（8例患者）。MRI和X线摄影对寰枢椎半脱位（20例患者）和C2以下半脱位（6例患者）的检测效果相同。MRI显示，所有患有压迫性脊髓病的III组患者脊髓均有形态改变。这种改变在II组和I组患者中较少见（3例患者），差异具有统计学意义（P<0.005，III组与I组和II组相比）。X线平片上测量的椎体脱位（以毫米为单位）与MRI上脊髓形态改变的存在之间未发现相关性。III组患者的脊髓造影显示，造影剂通过受阻的水平与MRI上所见脊髓形态改变的水平相同。这些发现表明，MRI可作为一种有用的非侵入性检查方法，用于诊断和管理疑似患有压迫性颈髓病的类风湿性关节炎患者。
