益赛普治疗强直性脊柱炎疗效观察及护理

目的:观察益赛普治疗强直性脊柱炎的效果与探讨护理策略.方法:在2009年1月1日-2010年12月31日2年期间,选我科住院的强直性脊柱炎疾病患者,共60例,随机平分为A、B两组,A组给予常规治疗+常规护理,B组在A组基础上加用益赛普治疗,并对B组给予加强护理.治疗三个月后观察两组患者的治疗效果,并对结果进行统计分析.结果:3个月后,A组中21例患者腰痛及晨僵症状明显减轻,骶髂关节活动障碍明显改善,血沉及C反应蛋白化验明显下降,2例大于3年病程的患者,在应用益赛普一次后,症状明显缓解.1例因关节僵硬、疼痛需长期卧床患者恢复生活自理.未发生严重不良反应;B组30例患者腰痛及晨僵症状明显减轻,骶髂关节活动障碍明显改善,血沉及C反应蛋白化验明显下降,6例病程大于3年的患者,在应用益赛普后即感觉症状明显缓解.4例因关节僵硬、疼痛需长期卧床患者恢复生活自理.无1例发生严重不良反应,两组各指标分别比较,差别有统计学意义(P＜0.05).结论:益赛普治疗强直性脊柱炎效果满意,同时加强护理也十分必要.     

强直性脊柱炎假关节的形成机制、影像学表现及治疗策略进展

正强直性脊柱炎(ankylosing spondylitis,AS)是一种主要累及脊柱、骶髂关节等中轴骨的慢性非特异性炎症性疾病~([1])。疾病进展期主要表现为疼痛、晨僵以及进行性发展的胸腰椎后凸畸形,晚期出现严重的脊柱畸形和关节强直~([2])。脊柱假关节作为强直性脊柱炎中晚期常见的并发症,最早由Andersson提出(即"Andersson损害")。由于缺乏明确的     

强直性脊柱炎和致密性骨炎患者骶髂关节病变多排螺旋CT鉴别诊断

目的探讨强直性脊柱炎和致密性骨炎患者骶髂关节病变CT影像表征,评估多排螺旋CT对两者骶髂关节病变的鉴别诊断价值。方法回顾性收集131例骶髂关节病变患者的一般资料以及多排螺旋CT影像学资料,其中强直性脊柱炎患者69例,致密性骨炎62例,比较两种疾病的一般资料和CT影像表现。结果强直性脊柱炎患者男性占大多数,而致密性骨炎患者全为女性;强直性脊柱炎患者的平均年龄较致密性骨炎患者低,但无显著统计学差异(P=0.339);强直性脊柱炎患者因四肢、腰骶关节等疼痛不适检查的病例数也显著高于致密性骨炎患者;强直性脊柱炎患者及致密性骨炎患者在CT影像表现方面,如关节面侵犯、骨质硬化、囊变以及关节间隙变     

低剂量64层螺旋CT在诊断强直性脊柱炎骶髂关节早期病变中的临床应用

目的探讨低剂量64层螺旋CT在诊断强直性脊柱炎骶髂关节早期病变中的价值。方法回顾性分析100例强直性脊柱炎骶髂关节早期病变患者的临床资料。结果早期强直性脊柱炎骶髂关节病变的影像学表现为髂骨侧关节面模糊不清,皮质部分消失或完全消失,靠近皮质部分的松质骨增生呈现出糜烂、硬化或者为硬密度不均匀呈现出"融雪状",骨小梁模糊,且随着病程的逐渐延长,还会导致骶骨侧面与韧带部位的不断发展以及关节内出现软组织肿胀等。结论低剂量64层螺旋CT能够清晰反映强直性脊柱炎骶髂关节早期病变患者的各种状况,对其早期诊断具有重要意义,可在临床推广与应用。     

儿童强直性脊柱炎临床特点分析

目的探讨儿童强直性脊柱炎的临床特点,为早期诊断提供依据。方法对32例儿童强直性脊柱炎患者的临床表现、影像学及实验室检查结果进行分析。结果虽然就诊症状各异,但所有患者均有骶髂关节炎的临床表现以及CT上以髂骨面改变为主的骶髂关节影像学改变以及血沉或C反应蛋白的升高。结论针对骶髂关节炎的物理学检查是发现本病的重要线索,而CT对确诊有重要价值,结合实验室检查更有利于早期发现本病。     

强直性脊柱炎患者顽固性腰骶部疼痛的手术治疗

目的 探讨骶髂关节病灶清除术治疗强直性脊柱炎顽固性腰骶部疼痛的临床疗效.方法 回顾性分析自2015-01-2017-12采取骶髂关节病灶清除术治疗的21例强直性脊柱炎顽固性骶髂关节疼痛,比较术前、术后1周、术后1个月、术后3个月、术后12个月疼痛VAS评分.结果 21例均顺利完成手术,随访时间12～36个月,平均18个...     

柳氮磺胺吡啶联合甲氨喋呤治疗强直性脊柱炎的临床疗效分析

目的：比较柳氮磺胺吡啶联合甲氨喋呤与单用甲氨喋呤治疗强直性脊柱炎的临床疗效与副反应。方法：回顾性总结了１０９例甲氨喋呤对组与１６例柳氮磺胺吡啶联合甲氨喋呤治疗组１年后,绎腰背痛、晨僵时间、外周关节痛、胸廓扩张度、Ｓｃｈｏｂｅｒ试验、血沉、Ｃ反应蛋白、Ｘ线骶髂关节改变的影响。结果：治疗组总有效率优于对照组,尤其对改善晨僵时间、外周关节痛、枕墙距、ＣＲＰ优于对照组。两组副反应均较轻,无差异。结论：柳氮     

CT、ECT在脊柱关节病诊断中的价值

目的 探讨CT、ECT核素骨显像对脊柱关节病（SpA)的诊断价值。方法 对临床诊断为SpA患者63例（其中强直性脊柱炎26例，未分化脊柱关节病37例）同时进行骶髂关节CT扫描和ECT全身及骶髂关节局部显像。结果 CT对未分化脊柱关节病检查阳性率为24.3%(9/37)。远低ECT检查阳性率64.9%(24/37)；ECT对强直性脊柱炎的诊断阳性率为53.8%(14/26)。结论 ECT核素骨显像早期诊断SpA较CT敏感，具有重要价值。     

CT与MRI诊断强直性脊柱炎骶髂关节病变的效果分析

目的分析CT与MRI诊断强直性脊柱炎骶髂关节病变的临床价值。方法选取2016-01—2017-03间温县人民医院收治的79例强直性脊柱炎患者,对其影像学资料进行回顾性分析,以比较CT及MRI检查对强直性脊柱炎骶髂关节病变的检出率和分级诊断的准确性。结果 MRI对Ⅰ级、Ⅱ级病变及软组织肿胀、腰5骶1关节突病变、关节面下骨质囊变及关节侵蚀的检出率均明显高于CT,差异有统计学意义(P0.05)。MRI和CT对0级、Ⅲ级及Ⅳ级病变及关节间隙狭窄或增宽、关节面增生硬化的检出率比较,差异无统计学意义(P0.05)。结论与CT比较,MRI诊断早期强直性脊柱炎骶髂关节病变效果较好,易于发现滑膜炎、骨髓水肿等急性炎性改变。     

强直性脊柱炎骨量丢失的中西医结合诊治进展

强直性脊柱炎是一种慢性进行性骨关节病,主要影响中轴骨骼并导致显着的疼痛和残疾。多见于青少年,主要侵犯骶髂关节、髋关节和脊柱,并且可伴有关节外表现。早期表现为肌腱、韧带附着点的炎症,进而出现关节骨质破坏,软骨内、韧带纤维化及异位骨化,造成脊柱关节强直改变,最终导致残废。在我国强直性脊柱炎的发病率约为0.3%,是临床最常见的风湿病之一,发病高峰年龄为15~30岁,男性的患病率比女性高2~3倍,且男性平均发病年龄要早于女性平均发病年龄。骨质疏松作为强直性脊柱炎最常见的一种并发症,以全身性骨病,以骨各种成分等比例减少而导致骨脆性增加、易发生骨折为特征,其发生率为50%~92%,并且有35%的强直性脊柱炎患者可发生因骨质疏松而导致椎体压缩性骨折。目前,强直性脊柱炎的治疗主要以西医为主,存在明显的局限性,中医中药可以充分弥补其不足,中西医结合多途径多靶点阻断骨量丢失,可望能为强直性脊柱炎的治疗拓展新思路,提供新方法。     

Randomized controlled trial on low level laser therapy (LLLT) in the treatment of osteoarthritis (OA) of the hand

BACKGROUND AND OBJECTIVES: Low level laser therapy (LLLT) offers promising symptomatic relief of osteoarthritic (OA) pain. We examined efficacy of active LLLT versus sham LLLT on finger joints and three superficial nerves. STUDY DESIGN/MATERIALS AND METHODS: OA-patients randomly assigned, received three treatments per week for 6 weeks of LLLT (n = 42) or sham LLLT (n = 46). RESULTS: Pain relief, morning stiffness, and functional status did not significantly improve for LLLT versus placebo. No significant differences were found in finger range of motion, except carpometacarpal opposition (P = 0.011), grip strength, and patient global assessment which improved for active LLLT participants (P = 0.041). CONCLUSIONS: LLLT is no better than placebo at reducing pain, morning stiffness, or improving functional status for OA-hand patients.     

Sexual function in ankylosing spondylitis: a study of 65 men

PURPOSE: We evaluated sexual function in male patients with ankylosing spondylitis (AS) using the validated International Index of Erectile Function (IIEF). We also assessed the frequency and association of erectile dysfunction with patient age, disease duration, morning stiffness, laboratory activity, disease severity, depression status and medication use in this patient group. MATERIALS AND METHODS: We evaluated sexual function, in particular erectile dysfunction (ED), using the IIEF in male patients with AS followed regularly at the outpatient clinic of rheumatology and compared results with those in healthy controls. Patient age, disease duration, morning stiffness, laboratory activity, disease severity and medication use were obtained by reviewing the medical record. Affective patient and control states were measured by the Beck Depression Inventory. The Bath AS Functional Index was used to measure functional status in AS cases. RESULTS: To our knowledge this is the first study of the frequency of ED in men with AS (8 of 65 or 12%). Compared to healthy controls patients with AS had significantly lower erectile function, orgasmic function, intercourse satisfaction and overall satisfaction scores according to the IIEF, whereas sexual desire scores were also lower, although not significantly. According to self-reported patient data ED was a prominent characteristic of our population. We were not able to relate any clinical features or laboratory findings to ED except the duration of morning stiffness. The 22 men with a high degree of morning stiffness (greater than 4 hours) had lower erectile function scores compared to the 12 with AS and a low degree of morning stiffness (less than 2 hours) (18.3 +/- 1.6 vs 26.5 +/- 2.4, p <0.05).Of 65 patients with AS 25 (38%) were depressed in our study group according to the Beck Depression Inventory, while no healthy controls were depressed when a score of greater than 13 was used as the cutoff. CONCLUSIONS: ED can be seen in the course of AS. The pathogenesis of ED in patients with AS is thought to be multifactorial with disease and treatment related factors. Thus, male patients with AS, in particular those with a high degree of morning stiffness, should be encouraged to talk about their sexuality.     

Clinical significance of MEFV mutations in ankylosing spondylitis

ObjectiveThe aim of the present study was to investigate the prevalence of MEFV gene mutations in patients with ankylosing spondylitis (AS) and to assess the clinical significance of the MEFV gene mutations in AS.MethodsEighty AS patients and 85 healthy controls were examined for 12 common MEFV mutations via strip-assay technique. Bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI), visual analogue scale (VAS) for pain, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Schober test, chest expansion measurements, hip involvement, ocular involvement, articular pain, and presence of syndesmophytes were used to assess the disease severity in patients.ResultsTwenty-four of the AS patients (30%) and 17 of the healthy controls (20%) were found to carry a single MEFV mutation. There was no significant difference between the AS patients and controls in terms of MEFV gene mutation frequency (p = 0.13, OR: 1.71, 95% CI: 0.83–3.50). When the patients were divided into two groups as MEFV mutation carriers and noncarriers, there was significant difference between the groups regarding BASFI and BASDAI whereas there was no significant difference in VAS score for pain. No association was found with the clinical findings and MEFV mutation except hip involvement. While there was no significant difference in CRP levels, individuals with MEFV mutation had a higher ESR than the noncarriers.ConclusionMEFV gene mutation carriage rate was not found to be significantly higher in AS patients when compared with healthy controls. However having an MEFV mutation seems to aggravate the disease course in AS.     

Improvement of the clinical outcome in Ankylosing spondylitis by balneotherapy

AIMS: This study is designed to show the efficacy of balneotherapy and balneotherapy (BT) + nonsteroid antiinflammatory drug (NSAID) use in Ankylosing spondylitis (AS) patients. METHODS: In this prospective study, BT, BT+ NSAID and NSAID therapy in 61 patients with AS were evaluated by ASAS core set. BT group (21 patients) was treated only with BT for 20 min, once a day, 5 days a week, over a period of 3 weeks. BT+NSAID group (20 patients) was treated with 1000 mg naproxen as well as BT. NSAID group (20 patients) was treated with 1000 mg naproxen. All of the participants did respiratory and postural exercises for 20 min a day and for the whole study period. Each patient was evaluated on admission (before treatment), at the end of the therapy and 6 months after the treatment. RESULTS: At the end of the study, statistically significant improvement was observed in all the clinical parameters of the patients in BT (G1), BT+NSAID (G2) and NSAID (G3) groups. This significant symptomatic and clinical improvement was maintained even 6 months after the treatment. The changes from baseline to follow up were similar in G1 and G2 except duration of morning stiffness (DMS) and chest expansion (CE). Improvements in CE and DMS were better in G1 and G2, respectively. Improvements observed in G1 and G2 were superior to the improvements observed in G3 for the variables of morning pain, nocturnal pain, DMS, global well being of the patient, occiput-wall distance, CE, finger to floor distance and functional index. In Schober test, improvement observed in G1 was statistically superior to G3. CONCLUSION: We concluded that BT can be suggested as an effective symptomatic treatment modality in patients with AS. Furthermore, sufficient improvement in clinical parameters can be obtained by BT alone.     

Microsurgical management of postoperative disc space infection

We analysed seventeen patients with septic postoperative spondylodiscitis (POD) who were managed by early microsurgical removal of the infected necrotic tissue, application of a closed suction-irrigation system (for a mean of 6.7 days), and early mobilisation. The POD was diagnosed clinically by elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) values and radiographically by computerised tomography scanning or magnetic resonance imaging. According to the sensitivity studies of the obtained pathogens, systemic antibiotics were given, followed by early mobilisation of all patients in a light cast corset. Immediate pain relief was noted in all patients except one, who required a third operation that was followed by rapid clinical improvement. Bacteriological diagnosis was obtained in 88% of the patients. Excellent or good clinical long-term results were achieved in 82% of the patients, whereas 18% had poor results. Elevated ESR/CRP values returned to normal ranges within 6 to 44 days (mean 15 days) after reoperation. All but one patient tolerated early mobilisation (within 2 to 4 weeks) well without any complication. Early microsurgical removal of the necrotic and infected tissue and application of a closed suction-irrigation system supported by specific antibiotic therapy should be considered an effective means to treat POD, thereby avoiding a prolonged period of unpleasant immobilisation for the patient.     

腰腿痛宁胶囊联合八段锦治疗早期类风湿关节炎42例临床观察

目的:观察腰腿痛宁胶囊联合八段锦治疗早期寒湿痹阻型类风湿关节炎的临床疗效及对血清炎性因子的影响,为临床治疗类风湿关节炎提供新思路.方法:将84例类风湿关节炎患者分为治疗组和对照组,每组42例.治疗组给予腰腿痛宁胶囊联合八段锦治疗,对照组给予甲氨蝶呤片治疗,根据病情临时使用对乙酰氨基酚.2组均以8周为1个疗程.观察2组临...     

Serological markers can lead to false negative diagnoses of periprosthetic infections following total knee arthroplasty

Periprosthetic infections following total knee arthroplasty (TKA) are diagnostically challenging. We evaluated the sensitivity and specificity of ESR and CRP, false negative rates, whether false negative rates differed between early post-operative and late infections, and the predictive ability of ESR and CRP to differentiate infected patients. Between 2000 and 2007, a prospectively collected database was reviewed to identify patients with suspected periprosthetic infections, and who had ESR and CRP laboratory values. One hundred and thirteen patients were identified. False negative rates were calculated. Finally, receiver operating characteristic curves were used to determine the predictive ability of ESR and CRP to differentiate infected from non-infected patients. CRP had a sensitivity of 95% and specificity of 20%. ESR had a sensitivity of 91% and a specificity of 33%. The false negative rate was 9.2% for ESR, 5.3% for CRP, and 11.1% for combined ESR and CRP. False negative rates were higher for early post-operative infections. Although ESR and CRP can be excellent adjunctive diagnostic tools, we emphasise that because some patients may not mount a sufficient immune response, the entire clinical picture must be evaluated, and periprosthetic infection should not be ruled out on the basis of ESR and CRP results alone.     

The association between heel ultrasound and hormone replacement therapy is modulated by a two-locus vitamin D and estrogen receptor genotype.

Evidence supports the role of estrogen deprivation in the process of bone remodeling and increased risk of fracture in postmenopausal women but little is known about the genetic basis of individual differences in response to therapy. In a cross-sectional study, 425 ambulatory postmenopausal French-Canadian women from Quebec (age range, 42-85 years old) were genotyped for a common Bsm I polymorphism at the vitamin D receptor (VDR) gene as well as a Pvu II polymorphism in the estrogen receptor (ESR1) gene. Heel ultrasound was determined by right calcaneal quantitative ultrasound (QUS) and results were expressed as an age-and-weight-adjusted stiffness index (heel SI z score). Our aim was to investigate the interaction between hormone-replacement therapy (HRT) and receptor genotypes in an effect on heel SI. Notably, a two-locus genotype (VDR-bb/ESR-PP) present in 9.5% of women was responsible for over 30% of the total HRT-related heel SI difference in the whole sample. Women bearing this combined VDR/ESR1 genotype who received HRT for more than 5 years had a 21% (1.25 SD) greater heel SI (p = 0.002) than those bearing the same genotype but who received HRT for <5 years. This may translate into a 2- to 3-fold difference in the risk of fracture. Although follow-up studies are needed, our findings suggest that QUS of the heel in postmenopausal women taking HRT is affected by variation in VDR and ESR1 loci, jointly.