布氏杆菌感染致脊柱炎的MR表现

目的:探讨布氏杆菌感染引起的脊柱炎的MR表现,旨在提高对该病的诊断水平.方法:本组13例均行MR检查和血清凝聚试验.结果:病灶多分布在腰椎,以L4发病率最高,受累椎体多伴有明显骨质增生,类似脊柱结核.结论:布氏杆菌感染引起的脊柱炎具有特征性MR表现,鉴别诊断应包括脊柱结核、强直性脊柱炎和化脓性脊柱炎.     

A MISDIAGNOSED CASE OF SACROILIAC JOINT INJURY AND MALPOSITION

Sacroiliac joint malposition is one of the main causes evoking lumbocrural pain. Because its clinical symptoms are similar to those induced either by lumbar intervertebral disc protrusion or by ankylosing spondylitis (AS) at the early stage, and because X-ray results taken at its early stage were not evident for differentiating the diseases, misdiagnosis may occur in some doctors due to lack of experience. The authors treated several cases of pain in hip joint, which had been diagnosed as ankylosing spondylitis.     

祛痹通络胶囊治疗强直性脊柱炎60例临床观察

目的：观察祛痹通络胶囊治疗强直性脊柱炎（AS）的临床疗效。方法：选择60例符合AS诊断标准和纳入标准的男性患者为研究对象，采用随机化原则进行分组，分为治疗组和对照组。治疗组采用祛痹通络胶囊配合扶他林片进行治疗，对照组采用扶他林片进行治疗。结果：治疗组与对照组治疗后脊柱活动度相关指标方面均有改善，且治疗组优于对照组（P〈0．05）。结论：祛痹通络胶囊对强直性脊柱炎具有良好的治疗效果。     

自发性炎性疾病双转基因小鼠的研究

目的 通过建立强直性脊柱炎HLA－B2704和hβ2m双转基因动物模型,证实HLA－B2704和hβ2m基因在双转基因小鼠自发性炎性疾病发病过程中的作用,为研究B27相关性疾病的病因学、预防和治疗提供有力的工具。方法 将HLA－B2704和hβ2m转基因阳性小鼠交配后出生的子代,应用PCR、斑点杂交、Southern杂交、RT－PCR、流式细胞术和免疫组织化学等方法进行筛选鉴定和表达检测。同时隔日观察小鼠的发病情况,发病鼠行HE染色观察病理变化。结果 有8只高拷贝双转基因小鼠2周左右出现皮肤病变,关节炎和趾甲变化等自发性炎性疾病表现,正常小鼠、B27单转基因小鼠和HLA－B27／hβ2m双转基因小鼠流式细胞计的检测结果分别为0．63％、7．87％、35．87％,双转基因小鼠的细胞膜表面可见HLA－B2704高表达,而在B27单转基因小鼠表达不明显。结论 HLA－B2704重链可诱发转基因小鼠发生自发性炎性疾病,hβ2m可与B27形成稳定的复合体,从而稳定和增强HLA－B2704在细胞膜表面的表达。     

电针结合推拿治疗肥大性脊椎炎的临床观察

目的：观察电针结合推拿治疗肥大性脊椎炎的疗效。方法：将118例病人随机分为3组，分别是电针配合推拿组、电针组、推拿组，并进行比较。结果：电针结合推拿组和电针组、推拿组相比有显著性差异（P〈0．05）。结论：电针结合推拿治疗肥大性脊椎炎疗效显著。     

强直性脊柱炎湿热血瘀证辨证要素研究初探

目的：研究强直性脊柱炎湿热血瘀证的辨证要素，探讨证候的研究方法。方法：把中医辨证理论方法与流行病学调研方法、多元统计分析方法有机地结合，选取就诊的强直性脊柱炎患者进行调查研究并对资料进行统计学处理。结果：聚类分析发现，强直性脊柱炎的主要症状为：腰脊活动受限、晨僵、腰骶疼痛、脊背疼痛。Logistic分析得出湿热血瘀证候诊断的主要症状，对证候的归属进行判断，以预测概率0．5为判别分界点，总正确率为88．10．4。判别式分析得出对湿热血瘀证诊断有帮助的症状，并建立判断函数，符合率为89．2％，灵敏度为77．3％，特异度为92．7％，Kappa值为0．695。结论：应用临床流行病学的调查方法并结合统计学分析进行证候研究，包括中医辨病和辨证要素的研究是可行的。     

强直性脊柱炎非骨水泥型全髋关节置换术后中期随访

目的:观察强直性脊柱炎非骨水泥型全髋关节置换术后中期的随访结果。方法:对37例(52髋)强直性脊柱炎非骨水泥型全髋关节置换术后患者进行了24～172个月,平均69个月的随访。临床随访根据Harris的评分方法进行评分,X线随访根据Gruen等和DeLee and Charnley分区法分别进行股骨柄和臼杯X线分析,根据Brooker等0～4级分级法进行异位骨化分级。结果:患者髋关节屈伸、收展、内外旋总活动度由术前的平均27°提高到术后平均152°。术后无脱位、感染等并发症发生。Harris评分术前平均为32(8～64)分,术后平均为82(64～96)分,其中优38髋,良8髋,可6髋,优良率88.5％。X线片分析未见假体松动,11髋(21.2％)发生异位骨化。结论:人工全髋关节置换术治疗强直性脊柱炎髋关节病变,中期可取得满意的临床效果。     

Pain and fatigue in patients with rheumatic disorders

Summary The purpose of the study was to investigate whether fibromyalgia patients (n=50) differed from patients with rheumatoid arthritis (n=22) and ankylosing spondylitis (n=31) with respect to pain experience, pain coping and fatigue. A high general pain intensity level was recorded by the McGill Pain Questionnaire (p<0.01) and the visual analogue scale (p<0.01) in the fibromyalgia group compared to the other groups. The pain was of continuous duration in the fibromyalgia patients while the rheumatoid arthritis and ankylosing spondylitis patients experienced intermittent pain. A high correlation between sensory and affective pain rating indexes was determined in all patient groups (p<0.01). No statistically significant difference between the groups in pain coping was recorded. A high frequency of reported gastrointestinal problems (p<0.01) and high intensity of fatigue (p<0.01) were seen in the fibromyalgia group compared to the other groups. In the fibromyalgia group there was no correlation between the sleep problems and fatigue intensity. Thus, the fibromyalgia patients differed from the other groups in reporting frequently shoulder and upper arm pain, continuous pain, higher levels of fatigue and pain intensities as well as high frequency of gastrointestinal problems.     

Isolated thoracic spine lesion: is this the presentation of a SAPHO syndrome? A case report

A case of an isolated lesion of the thoracic spine attributed to SAPHO syndrome is presented. A 51-year-old man was referred for inflammatory pain in the thoracic spine. The general examination was normal (especially cutaneous and rheumatologic examinations). Laboratory analysis showed only a mild inflammatory reaction. Standard radiographs showed partial condensation of T8. Computed tomography showed osteolysis of the anterior corner of T8, and MRI revealed an abnormal signal of T8, with enlargement of the prevertebral soft tissue. Percutaneous and thoracoscopic biopsies showed a nonspecific inflammatory process, and cultures were sterile. Initially, several diagnoses were advanced: infectious spondylitis, malignant tumor, lymphomas, Paget disease, seronegative spondyloarthropathies and finally atypical SAPHO syndrome. Three months later, the patient experienced more pain. General examination was still normal. The radiological findings worsened, while the inflammatory blood tests were normal. A new thoracoscopic biopsy revealed a nonspecific inflammatory process. A diagnosis of SAPHO syndrome was made, despite the lack of typical lesions. Dramatically improving with anti-inflammatory therapy, the patients condition was favorable at 3-year follow-up. This atypical presentation of an isolated lesion in the spine makes the diagnosis of a SAPHO syndrome difficult but possible. Spine surgeons must be aware of this rare entity, to avoid misdiagnosis and unnecessary repeated surgical biopsies.     

Postoperative spondylitis after posterior lumbar interbody fusion using cages

The recommended surgical options for postoperative wound infections after instrumented spine surgery include a wide debridement and irrigation with antibiotics. In most cases, implant removal is not recommended for a solid fusion. However, there are few reports on the treatment choices for persistent postoperative wound infections following a posterior lumbar interbody fusion (PLIF) using cages. This paper reviewed ten patients referred to our department, who underwent revision surgery for a postoperative, deep infection after a PLIF with cages. The surgery included an anterior radical debridement and interbody fusion with removal of all implants. The clinical and laboratory results, including a bacteriologic study for the causative organism and the radiological changes, were analyzed. All patients complained of persistent severe back pain after the primary surgery. MRSA was the main organism found in these patients (five cases). Complete bony fusion was obtained in nine patients (90%). In one patient, back pain and radiating pain prevented him from returning to his original work. Despite the anterior interbody fusion with an autogenous iliac bone graft, all cases had a complete collapse of the intervertebral disc space, without a dislodgement or collapse of the graft bone. The mean loss of the height and lordosis in the involved segment was 12.7 mm (range 4–46 mm) and 5.6° (range 0–15°), respectively. Anterior radical debridement with the removal of all implants would be an effective way to manage patients with postoperative spondylitis after a PLIF using cages.