以外周关节炎为主症的青少年强直性脊柱炎

目的探讨反复发作的外周关节炎,作为青少年强直性脊柱炎(ankylosing spondylitis,AS)的主要临床表现,避免该病的误诊误治。方法12例15—20岁的青少年男性,其中髋关节炎8例,踝关节炎3例,足跟末端跟腱炎1例。本组病例查RF全部阴性。结果12例HLA—B27( ),影像学检查有骶髂关节炎10例。跟痛症者行骨刺切除、跟骨钻孔减压,效果不理想,全部患者行柳氮磺吡啶(SASP)、雷公藤多甙(T2)、甲氨蝶呤(MTX)规范性治疗,急性期加用抗生素,骶髂关节炎严重者行糖皮质激素封闭治疗,血沉降至正常后药物减量或停药。结论青少年外周关节炎、排除化脓性感染后,查RF阴性者要追踪影像学上骶髂关节的变化,检查HLA—B27,避免漏诊AS,青少年AS早期可以没有炎症性腰痛,骨盆X线片、检查骶髂关节可以未视及变化。     

骶髂关节结核的误诊及早期诊断

目的探讨骶髂关节结核误诊原因及提高其早期诊断措施。方法回顾性分析17例骶髂关节结核临床表现、体征及影像学特征，了解误诊情况。结果本组病例早期误诊率较高，17例中16例曾误诊为其他疾病。结论骶髂关节结核进展缓慢，早期症状及影像学表现不典型，且与骶髂关节其他疾病相类似是误诊的主要原因。掌握其发病特征，结合骶髂关节被动运动性疼痛试验检查，早期骶髂关节正位片及CT检查是提高其早期诊断的主要措施。     

骶髂关节功能紊乱所致下腰痛的诊断和手法治疗

由骶髂关节的紊乱引起的慢性下腰痛约占整个下腰痛的10％～27％。临床上对其诊断尚缺乏必要的病史、体格检查和影像学的证据。本文对1997—2007年的MEDLINE数据库，Cochrane Reviews进行检索，回顾近10年来国内外关于骶髂关节所致下腰痛的诊断，以及推拿手法对其干预研究情况的文献资料，对骶髂关节紊乱所致下腰痛的诊断和治疗方法进行总结，以期有助于提高骶髂关节紊乱所致下腰痛的诊治效果。     

强直性脊柱炎致骶髂关节炎的X线与CT诊断

目的评估X线、CT对强直性脊柱炎(AS)患者骶髂关节炎的诊断价值。方法对64例AS的临床X线、CT结果进行分析、归纳和总结。结果单侧骶髂关节改变24例,双侧骶髂关节改变40例。骶髂关节X线显示为正常1例,可疑异常12例,轻度骶髂关节炎23例,中度骶髂关节炎20例,重度骶髂关节炎8例。CT检查显示为正常0例,可疑异常6例,轻度骶髂关节炎29例,中度骶髂关节炎21例,重度骶髂关节炎8例。64例中58例人类白细胞抗原B27(HLA-B27)抗原阳性。结论X线正位加左、右斜位平片能对大部分骶髂关节炎作出诊断,尤其是中晚期改变。对于骶髂关节炎的早期诊断,CT优于X线平片。     

旋转和垂直不稳定型骨盆骨折的手术治疗

目的：探讨旋转和垂直不稳定型骨盆骨折的临床特点及其治疗方法选择。方法：17例存在旋转和垂直不稳定的骨盆骨折患者，全部行手术治疗：骨盆前环均行切开复位内固定，骨盆后环11例采用行切开复位双钢板固定，6例在CT引导下经皮置入松质骨螺钉固定骶髂关节。结果：17例全部恢复行走功能，11例行前路切开骶髂关节双钢板固定患者中骨盆外形恢复好，但1例沿髂嵴切口有不适，6例CT引导下经皮置入骶髂关节螺钉患者骨盆外形接近完全恢复，功能恢复快而满意。结论：骶髂关节骨折脱位患者非手术治疗效果差，宜首选内固定手术治疗；而CT引导下经皮置入骶髂关节螺钉手术操作简单、时间短、出血少、损伤少、固定牢靠，是固定骶髂关节的好方法。     

手法整复骶髂关节半脱位18例报告

手法整复骶髂关节半脱位１８例报告袁风张小勇陈仕龙黄振双骶髂关节半脱位可引发腰腿痛［１］。作者从１９９４年１０月到１９９６年２月，共诊治单侧骶髂关节半脱位１８例，经手法整复，疗效良好。１临床资料本组共１８例，女１６例，男２例。年龄在２５～７５岁，２５～...     

HLA-B27阳性与阴性强直性脊柱炎患者骨密度的对比分析

目的探讨HLA-B27阳性和阴性AS患者BMD的特点,及两组BMD与其他指标的相关性分析。方法回顾性调查2006年3月至2014年12月中日友好医院中医风湿病科确诊为AS的患者,其中HLA-B27阳性AS患者352例,HLA-B27阴性AS患者99例,双光能X线法检测腰椎、股骨颈、股骨粗隆的BMD,并与年龄、病程、疾病活动性指标、影像学指标、体征进行相关分析。结果 1HLA-B27阳性AS患者各部位BMD较阴性组显著降低;阳性AS患者OP及OT率66.76%,显著高于阴性组OP及OT率41.41%;阳性AS患者腰椎OP发生率、股骨颈、股骨粗隆OT发生率高于阴性组(P0.01、0.01、0.05)。2低年龄组(20~29岁)HLA-B27阳性AS患者的腰椎、股骨颈BMD低于阴性组;高年龄组(40~45岁)HLA-B27阳性AS患者的腰椎BMD显著低于阴性组。病程5年,HLA-B27阳性AS患者的腰椎BMD低于阴性组;5-10年,阳性AS患者各部位BMD显著低于阴性组(P0.05、0.01、0.05、0.01)。3HLA-B27阳性AS患者各部位BMD与年龄、体征具有显著相关性(P0.01)。结论 HLA-B27阳性AS患者OP及OT的发生率较阴性患者高,各部位BMD下降程度更明显,尤其是腰椎BMD;HLA-B27阳性AS患者在青年阶段、发病早中期即可出现骨密度的下降,且随着骨密度的下降,功能活动减退。所以对HLAB27阳性患者更要重视及早进行OP及OT的筛查、预防和诊治,尤其要注重腰椎BMD的检查。     

骶髂关节骨折脱位的手术治疗

目的报告骶髂关节骨折脱位切开复位内固定的方法和治疗效果.方法采用骶髂关节前部切口,显露骶髋关节前面,复位后应用骨盆钢板内固定并植骨融合.结果45例骶髂关节骨折脱位均施行切开复位内固定融合术,随访8～20个月,骶髂关节完全融合,骨盆稳定.结论骶髂关节的完整对骨盆环的稳定性起着重要作用,当发生骨折脱位时应及时手术治疗,恢复其稳定性.     

以外周关节受累为首发症的强直性脊柱炎临床特点及误诊分析

目的探讨以外周关节受累为首发症的强直性脊柱炎临床特点并对误诊原因进行分析。方法回顾性分析2003年1月～2005年12月诊治的26例以外周关节受累为首发症的强直性脊柱炎的临床特点,分析误诊原因。结果26例患者中有17例曾在外院及本院门诊被误诊,误诊率为65．4%,误诊疾病有化脓性关节炎、风湿性关节炎等。结论以外周关节受累为首发症的强直性脊柱炎早期症状不典型,容易误诊误治,应加强对其临床特点的认识,对疑似强直性脊柱炎患者应常规行双侧骶髂关节CT检查及血HLA-B27检查。     

旋转和垂直不稳定型骨盆骨折的手术治疗

目的 探讨旋转和垂直不稳定型骨盆骨折的临床特点及其治疗方法选择。方法 17例存在旋转和垂直不稳定的骨盆骨折患者,全部行手术治疗:骨盆前环均行切开复位内固定,骨盆后环11例采用行切开复位双钢板固定,6例在CT引导下经皮置入松质骨螺钉固定骶髂关节。结果 17例全部恢复行走功能,11例行前路切开骶髂关节双钢板固定患者中骨盆外形恢复好,但1例沿髂嵴切口有不适,6例CT引导下经皮置入骶髂关节螺钉患者骨盆外形接近完全恢复,功能恢复快而满意。结论 骶髂关节骨折脱位患者非手术治疗效果差,宜首选内固定手术治疗;而CT引导下经皮置入骶髂关节螺钉手术操作简单、时间短、出血少、损伤少、固定牢靠,是固定骶髂关节的好方法。     

Computed tomography findings in patients with sacroiliac pain

This retrospective study evaluated the diagnostic value of computed tomography in patients with sacroiliac pain. Computed tomography scans of the sacroiliac joints of 62 patients with sacroiliac joint pain were reviewed. The criteria to include the patient in the current study were pain relief after a local injection in the sacroiliac joint under computed tomography guidance, a physical examination consistent with a sacroiliac origin of the pain, and negative magnetic resonance imaging of the lumbar spine. A control group consisted of 50 patients of matched age who had computed tomography scans of the pelvis for a reason other than pelvic or back pain. Computed tomography scans showed one or more findings in 57.5% and 31% of the sacroiliac joints in the symptomatic and the control groups, respectively. The computed tomography scans were negative in 37 (42.5%) symptomatic sacroiliac joints with a positive sacroiliac joint injection test. The sensitivity of computed tomography was 57.5 % and its specificity was 69%. The finding of the current study suggests limited diagnostic value of computed tomography in sacroiliac joint disease because of its low sensitivity and specificity. With clinical suspicion of a sacroiliac origin of pain, intraarticular injection is currently the only means to confirm that diagnosis.     

The early diagnosis of sacroiliac joint infections in children

We retrospectively reviewed the medical records and imaging studies of 15 children with infections of the sacroiliac joint to determine the usefulness of specific examinations and studies to aid in the early diagnosis of this condition. The clinical presentation, physical examination findings, pertinent laboratory data, and imaging studies were reviewed. Thirteen patients (87%) were febrile at the time of presentation. One patient presented in septic shock requiring intubation and critical care management. Tenderness to palpation over the sacroiliac joint was present in all 9 patients who had this examination performed, and the flexion abduction external rotation test was positive in 10 of 12 patients (83%) who had this test done. Laboratory indicators of infection were elevated in most patients, and 6 patients (46%) had positive blood cultures, most commonly growing Staphylococcus aureus. Initial conventional radiographs were negative in all but 1 patient. Radionuclide 99-m-technetium bone scans were positive in 7 of 10 patients (70%), and magnetic resonance imaging studies were ultimately positive in 13 of 14 patients (93%). However, within the first 6 days after the onset of symptoms, only 5 of 8 bone scans (63%) and 5 of 9 magnetic resonance imaging studies (57%) were consistent with infection. We conclude that while diagnostic imaging studies are ultimately helpful in confirming the diagnosis of sacroiliac joint infections in children, studies made within 6 days of the onset of symptoms may not always confirm the diagnosis. The early diagnosis of this condition is best made on the basis of clinical and laboratory findings.Level of Evidence: Therapeutic Study, level IV (Case series [no, or historical control group]).     

HLA-B27与强直性脊柱炎的相关性研究进展

背景 强直性脊柱炎(ankylosing spondylitis,AS)是一种常见的自身免疫性关节病,好发于年轻男性,该疾病目前早期诊断较闲难,治疗效果不理想,以往研究表明HLA-B27与AS有很强的相关性,90%左右的AS患者HLA-B27呈阳性,但是仍有10%的患者HLA-B27呈阴性,值得临床进一步研究.目的 现...     

Radiologic case study. Pyogenic left sacroiliac infection

A wide variety of inflammatory, infectious, metabolic, and neoplastic diseases can affect the sacroiliac joints. Early in their course, some of these diseases produce only subtle and nonspecific signs and symptoms. Demonstration of characteristic joint changes, knowledge of specific clinical manifestations, and familiarity with imaging modalities can lead to early diagnosis and treatment of these patients.     

Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint.

BACKGROUND CONTEXT: The sacroiliac joint is known to be a possible cause of chronic low back pain, but the diagnosis and treatment of disorders of the sacroiliac joint have been difficult and controversial. PURPOSE: To describe the outcome of sacroiliac joint arthrodesis for sacroiliac joint disorders, with the hypothesis that sacroiliac arthrodesis leads to improved postoperative function. STUDY DESIGN/SETTING: Consecutive case series performed in an academic medical institution. PATIENT SAMPLE: The patient population consisted of 20 patients undergoing sacroiliac joint arthrodesis between December 1994 and December 2001. Patients undergoing concomitant procedures at the time of sacroiliac joint arthrodesis were excluded. The 3 men and 17 women in the study group had an average age of 45.1 years (range 21.8-66.4 years), a mean duration of symptoms of 2.6 years (range 0.5-8.0 years), and a mean follow-up period of 5.8 years (range 2.0-9.0 years). OUTCOME MEASURES: Outcome measures included general health and function, clinical evaluation, and radiographic assessment. METHODS: For all 20 patients, nonoperative treatment had failed, and for all, the diagnosis was confirmed by pain relief with intraarticular sacroiliac joint injections under fluoroscopic guidance. Sacroiliac joint arthrodesis (via a modified Smith-Petersen technique) was recommended only when a positive response to the injection was noted, and patients had recurrence of symptoms after the initial positive response. Preoperative and postoperative general health and function were assessed via the 36-item Short-Form (SF-36) Health Survey and American Academy of Orthopaedic Surgeons (AAOS) Modems Instrument, which were collected prospectively. Medical records and plain radiographs were reviewed retrospectively to determine the clinical and radiographic outcome. RESULTS: Multiple etiologies of sacroiliac symptoms were observed: sacroiliac joint dysfunction (13 patients), osteoarthritis (5 patients), and spondyloarthropathy and sacroiliac joint instability (1 each). Seventeen patients (85%) had solid fusion. Fifteen patients (75%) completed preoperative and postoperative SF-36 forms. Significant (p< or =.05) improvement occurred in the following categories: physical functioning, role physical, bodily pain, vitality, social functioning, role emotional, and neurogenic and pain indices. Improvement (not statistically significant) was also noted in general and mental health. CONCLUSIONS: For carefully selected patients, sacroiliac arthrodesis appears to be a safe, well-tolerated, and successful procedure, leading to significant improvement in functional outcome and a high fusion rate. To the authors' knowledge, the current report is the largest series to document the functional and radiographic outcome of sacroiliac joint arthrodesis.     

Hip involvement in patients with familial Mediterranean fever. A review of ten cases

Hip involvement is uncommon in familial Mediterranean fever (FMF) and can result either from a process specific to this disease or from a coexisting chronic inflammatory joint disease, usually suggestive of ankylosing spondylitis (AS). We report ten cases of FMF with radiologically-documented inflammatory hip disease. Five patients had AS and one had juvenile idiopathic arthritis. There were six men and four women, with a mean age of 34.4 years +/- 17.6 (range, 15-70 years). Onset of the inflammatory hip disease occurred after bouts of acute hip symptoms in one of the patients with isolated FMF and after protracted hip arthritis in another; the two other patients had no history of hip symptoms. The HLA-B27 antigen was looked for in two of the five patients with FMF and AS, with negative results in both; another patient in this subgroup had severe ulcerative colitis. Total hip replacement or replacement of the acetabulum was required in six patients, including two with isolated FMF. Chronic joint disease has been estimated to contribute fewer than 5% of the joint manifestations in FMF. In previous studies, the hips and knees were affected in 75% of patients with chronic joint disease related to FMF. The association of FMF and AS (usually without the HLA-B27 antigen) has been well documented, although the pathogenic mechanisms that link these two conditions remain unknown.     

术中导航三维影像系统辅助置入骶骨钉微创治疗骶髂关节脱位

目的探讨手术导航一术中三维影像系统监测下置人骶骨钉微创治疗骶髂关节脱位的疗效。方法在手术导航一术中三维影像系统监测下应用骶骨钉内固定技术治疗15例骶髂关节脱位患者。其中骶髂关节半脱位6例，骶髂关节完全脱位9例；伴有骨盆前环损伤7例，伴有骶丛损伤2例。结果15例均获得6-16个月随访，复位均满意，无骶髂部疼痛14例，轻度疼痛1例；2例骶丛损伤者术后恢复良好。结论手术导航一术中三维影像系统监测下骶骨钉治疗骶髂关节脱位，是一种安全、有效的治疗方法，手术创伤小，时间短，康复快。     

Pathophysiology of ankylosing spondylitis: What's new?

Ankylosing spondylitis is a chronic inflammatory joint disease that predominantly affects the sacroiliac joints and spine. Its pathophysiology remains one of the most vexing enigmas of rheumatology. However, new insights have been provided by the recent identification of susceptibility genes other than HLA-B27; evidence of a pivotal role for several proinflammatory cytokines including interleukins 23 and 17; and the recognition that inflammation and structural progression proceed separately from each other.     

Les coxites au cours de la maladie périodique. À propos de dix cas

Hip involvement is uncommon in familial Mediterranean fever (FMF) and can result either from a process specific to this disease or from a coexisting chronic inflammatory joint disease, usually suggestive of ankylosing spondylitis (AS). We report ten cases of FMF with radiologically-documented inflammatory hip disease. Five patients had AS and one had juvenile idiopathic arthritis. There were six men and four women, with a mean age of 34.4 years ± 17.6 (range, 15-70 years). Onset of the inflammatory hip disease occurred after bouts of acute hip symptoms in one of the patients with isolated FMF and after protracted hip arthritis in another; the two other patients had no history of hip symptoms. The HLA-B27 antigen was looked for in two of the five patients with FMF and AS, with negative results in both; another patient in this subgroup had severe ulcerative colitis. Total hip replacement or replacement of the acetabulum was required in six patients, including two with isolated FMF. Chronic joint disease has been estimated to contribute fewer than 5% of the joint manifestations in FMF. In previous studies, the hips and knees were affected in 75% of patients with chronic joint disease related to FMF. The association of FMF and AS (usually without the HLA-B27 antigen) has been well documented, although the pathogenic mechanisms that link these two conditions remain unknown.     

The role of HLA-B27 in the diagnosis of low back pain.

The HLA-B27 antigen was determined in 652 patients with low back pain which had lasted for more than 3 months. A clinical and roentgenological examination of the sacroiliac joints and the thoraco-lumbar spine was performed in all the patients. The control group consisted of 302 unrelated persons who did not show signs of low back pain. Antigen HLA-B27 was found in 276 of these 652 patients attending the ward for rheumatic diseases (42.4 per cent) and in 37 of the 302 unrelated persons in the control group (12.2 per cent). The difference is statistically highly significant (P less than 0.001). Ankylosing spondylitis was found in 128 out of the 276 patients with low back pain and antigen HLA-B27. This demonstrates the importance of this antigen in the differential diagnosis of low back pain.