結石性痛風引起第一頸椎向前性半脫位

Tophaceous Gout Causing Anterior Subluxation of the First Cervical Vertebra

一位五十二歲男性，具有二十三年的長期痛風病史。在兩個月前曾有一次短暫性昏厥。最近兩個月因後枕部劇痛而入院檢查。經電腦斷層攝影及脊髓攝影發現第一及第二頸椎有向前性的半脫位，第二頸椎之齒樣突有糜爛，而且脊髓受到壓迫。經手術後發現在第一及第二頸椎間的手術樣本有粉筆狀的白色物質。經病理組織學檢查證實為結石性痛風引起之第一及第二頸椎向前性半脫位。結石性痛風侵犯脊椎而引起各種脊髓壓迫症狀，相當少見。尤其是以第一及第二頸椎半脫位作為表現更屬罕見。對於臨床上有長期痛風病史或有結石性痛風者，同時合併有脊髓壓迫症狀，在鑑別診斷上必須把結石性痛風列入考慮。

A 52-year-old man with a 23-year history of gout, presented with an episode of syncope and neck pain radiating to the occipital area for two months. A computerized tomography scan and a cervical myelography confirmed the presence of an anterior subluxation of the atlas onto the axis, together with erosion of the odontoid process and compression of the spinal cord. At operation, white chalky material was found in the joint space between the first and second cervical vertebrae. Laboratory and histologic studies suggested that the anterior subluxation of the first and second cervical vertebrae was caused by tophaceous gout.