无柄人工髋关节置换的近期疗效

人工髋关节置换术已是骨科医生常见手术,技术掌握已非常成熟,效果显著,大大提高了患者的生活质量。但伴随的脱位、骨溶解、下沉、骨水泥致敏、假体松动等并发症也时有发生。若遇需要翻修的病例,也给操作者带来一定的困难。另外,如遇青壮年患者的股骨头坏死或强直性脊柱炎并髋关节强直等骨病,按传统也只能选择半髋或全髋置换。2008年3—10月试用无柄人工髋关节置换5例,获得满意效果,报告如下。     

强直性脊柱炎骶髂关节病变的低场MRI诊断价值分析

目的 探讨强直性脊柱炎(AS)骶髂关节(SIJ)病变的低场MRI的诊断价值.方法 回顾性分析临床确诊的37例ASSIJ病变患者的MRI表现,并与X线、CT表现进行比较.结果 37例AS患者中,34例MRI显示SIJ软骨异常、19例显示关节下骨髓水肿、21例显示脂肪沉积、29例显示骨质破坏、11例合并髋关节病变.X线平片检出SIJ病变0～Ⅰ级14例、Ⅱ级4例、Ⅲ级14例、Ⅳ级5例;CT检出SIJ病变0级4例、I级3例、Ⅱ级12例、Ⅲ级13例、IV级5例;MRI检出SIJ病变Ⅰ级7例、Ⅱ级14例、Ⅲ级11例、Ⅳ级5例.结论 低场MRI可清晰地显示SIJ软骨异常、骨髓水肿、脂肪沉积及早期骨侵蚀改变,是ASSIJ病变早期首选影像学诊断方法.     

埋线刺络法治疗强直性脊柱炎临床观察

目的:探讨埋线刺络法治疗强直性脊柱炎(AS)的疗效和安全性.方法:86例AS患者随 机分为埋线刺络组(43例)和药物组(43例),分别予埋线刺络治疗(穴取肾俞、大抒、夹脊等)和口服柳氮磺胺吡啶(SASP)治疗,连续治疗8周,比较治疗前后症状积分、疼痛视觉模拟评分(VAS)、晨僵时间、Schoher试验、枕墙距、胸廓活动度及血沉(ESR)、C反应蛋白(CRP)的变化.结果:埋线刺络组总有效率为83.7%(36/43),优于药物组的70.0%(28/40)(P＜0.05).两组的全部观察指标均较治疗前明显改善(均P＜0.01),且埋线刺络组症状积分、Schober试验和疼痛VAS评分的改善程度明显优于药物组(P＜0.01,P＜0.05),并且埋线刺络组无不良反应.结论:埋线刺络法治疗强直性脊柱炎疗效确切、无不良反应,优于口服柳氮磺胺吡啶.     

Cauda equina syndrome complicating ankylosing spondylitis: Role of computed tomography and magnetic resonance imaging

Summary We present two cases of cauda equina syndrome in ankylosing spondylitis. Cauda equina syndrome is a rare complication of ankylosing spondylitis, the pathogenesis of which is not well understood. The onset is insidious with pain and sensory symptoms; sphincter disturbances are common. After a period of increasing neurological symptoms, the condition tends to stabilize. The degree of nerve involvement is variable and can be accurately defined by electromyography. The diagnosis has to be confirmed by computed tomography (CT) or magnetic resonance imaging (MRI); myelography must be avoided. There is no specific treatment, except for pain control.The different clinical presentations and the role of new imaging techniques, CT and MRI, are demonstrated.     

幼年强直性脊柱炎临床X线分析

笔者报告４６例幼年强直性脊柱炎。重点分析了本病侵犯骶髂关节、脊柱、外周关节及附病时的Ｘ线表现。鉴于本病在临床及Ｘ线诊断中与幼年类风湿性关节炎及成人强直性脊柱炎存在某些混淆，重点讨论了本病与后二者的鉴别诊断。     

Serum secretory immunoglobulins in ankylosing spondylitis

Summary Humoral mucosal immunity may be implicated in pathophysiology of ankylosing spondylitis (AS). The aim of the study was to evaluate serum levels of IgA, IgM and secretory IgA (sIgA), secretory IgM (sIgM) as well as free secretory component (FSC) in patients with AS compared to controls and rheumatoid arthritis (RA) patients.Levels of sIgA, sIgM and FSC were measured with a specific ELISA in 37 AS patients, 45 controls and 27 RA. The results were as follows: Serum levels of IgA were higher in AS vs controls and in RA vs controls (p=0.01). Levels of sIgA were higher in AS vs controls (p=0.01), but higher in RA vs AS (p=10^–4). There was no difference of sIgM in AS vs controls, FSC levels were higher in AS vs controls, and higher in AS patients with elevated CRP.In view of elevated FSC, this increase of sIgA in AS may have been due to excessive production of mucosal IgA after bacterial stimulation according to the current hypothesis of the disease.     

Copy number variations of the IL-22 gene are associated with ankylosing spondylitis: A case-control study in Chinese Han population

IL-22 provides a new insight into the mechanisms of autoimmunity, and copy number variations (CNVs) are associated with autoimmune diseases. This study aims to explore the association of IL-22 gene CNVs with ankylosing spondylitis (AS) susceptibility. The copy numbers of IL-22 gene (2 fragments: IL-22_1, IL-22_2) were examined by AccuCopy? methods in a cohort of 649 AS patients and 628 controls. Association of IL-22 CNVs and AS susceptibility was analyzed, and AS risk was estimated by Odds Ratio (ORs) and 95% confidence intervals (CIs), and the Benjamini-Hochberg method was applied to regulate the false discovery rate (FDR). We found one copy of IL-22 gene was significantly associated with AS [OR = 0.345, 95%CI (0.144, 0.827), P = 0.013, P_FDR = 0.026] in the IL-22_2 fragment, and this association still exist after adjustment of age and sex [OR = 0.344, 95%CI (0.143, 0.825), P = 0.017, P_FDR = 0.034]. In the stratification analysis by gender, the statistical difference was detected in males in the IL-22_2 fragment [OR = 0.306, 95%CI (0.121, 0.778), P = 0.009, P_FDR = 0.018; adjusted OR = 0.306, 95%CI (0.120, 0.777), P = 0.013, P_FDR = 0.026]. We suggest that IL-22 CNVs are associated with AS and that lower copy number might be a protective factor for AS, especially in male patients.     

强直性脊柱炎胸腰段后凸畸形矫形前后影像学参数分析

【摘要】 目的 通过对强直性脊柱炎（ankylosing spondylitis, AS）僵硬性胸腰段后凸畸形矫形前后影像学参数对比分析及相关性研究,探讨经椎弓根椎体截骨（pedicle subtraction osteotomy,PSO）矫形对矢状面脊柱骨盆序列的影响,进而探究AS后凸患者脊柱骨盆序列的代偿机制。 方法 2004年1月～2010年3月, 38例AS僵硬性胸腰段后凸畸形患者行后路单节段或双节段截骨矫形椎弓根螺钉内固定术。矫形前后拍摄全脊柱侧位X线片,测量AS患者全脊柱后凸角（Cobb T1~S1）、矢状面平衡距离（sagittal vertical axis,SVA）、骨盆入射角（pelvic incidence,PI）、骨盆倾斜角（pelvic tilt,PT）、骶骨倾斜角（sacral slope,SS）及截骨角度（PSO angle）。观察矫形前后影像学参数变化,控制影响患者个体差异的因素,将影像学参数做偏相关分析。 结果 矫形前,Cobb T1~S1=56°±28°,PI=45°±9°,PT=38°±13°,SS=7°±12°,SVA=21 cm±9 cm;矫形后,Cobb T1~S1=11°±22°,PI=46°±9°,PT=21°±10°,SS=24°±9°,SVA=9 cm±5 cm。矫形前,PT、SVA与Cobb T1~S1偏相关系数分别为r=0.81（P＜0.01）、0.64（P＜0.01）;矫形后,PT、SVA与Cobb T1S1偏相关系数分别为r=0.58（P＜0.05）、0.72（P＜0.01）。PSO angle与Cobb T1~S1、PT偏相关系数分别为r=－0.82（P＜0.01）、－0.56（P＜0.05）,PSO angle与SVA无相关性。 结论 矫形前后,AS患者通过后旋骨盆代偿全脊柱后凸所致的矢状面失平衡;骨盆后旋程度、矢状面平衡距离与全脊柱后凸程度呈正相关;人体自身代偿机制优先恢复骨盆的中立状态而非改善矢状面平衡距离。     

Arthroplasty for temporomandibular joint ankylosis secondary to ankylosing spondylitis

Summary Although temporomandibular joint involvement is frequent in ankylosing spondylitis, ankylosis seldom ensues. A patient with a temporomandibular joint ankylosis secondary to ankylosing spondylitis is presented. Treatment consisted of an osteoarthrectomy, followed by a costochondral ribgraft. A follow-up period of 39 months showed a satisfactory result.     

Ankylosing spondylitis presenting as spondylodiscitis

Summary Spondylopathy is a relatively common finding in advanced ankylosing spondylitis (AS). However noninfectious spondylodiscitis as an early manifestation of AS seems to be exceptional. In this article, we present such a case in an adolescent.