强直性脊柱炎运动治疗的研究进展

强直性脊柱炎(ankylosing spondylitis,AS)是一种以累及脊柱和骶髂关节为特征的系统性炎性疾病,临床上表现为炎性腰背痛、僵硬及活动受限,部分患者可有外周关节炎、髋关节受累、肌腱端病、眼炎及其他关节外表现。本病好发于15～30岁青年男性,我国患病率约为0.3%。研究表明,约1/3的AS     

影响强直性脊柱炎患者治疗依从性相关因素分析

目的调查影响强直性脊柱炎患者治疗依从性及不依从的原因。方法采用一般资料问卷和治疗依从性测评表调查100例强直性脊柱炎患者治疗依从性,比较依从组与不依从组患者性别、年龄、婚姻状况、文化程度等因素上的差异,并对不依从的原因进行调查。结果强直性脊柱炎治疗依从率为38．00％;强直性脊柱炎患者的治疗依从性女性高于男性、已婚者高于未婚者、文化程度较高者高于较低者（P〈0．05）;强直性脊柱炎患者治疗依从差的原因为知识缺乏、自身因素、治疗费用昂贵等。结论强直性脊柱炎患者治疗依从性较差,其原因较多,应实施有针对性的护理措施以提高其依从性。     

Spontaneous epidural abscess: Analysis of 15 cases with emphasis on diagnostic and prognostic factors

PurposeTo describe the incidence and characterize the clinical manifestations, diagnosis and outcome of spontaneous epidural abscess (SEA) not associated with neurosurgical procedures or instrumentation of the spine.MethodsReview of cases of SEA over 10 years. Diagnosis was made by imaging-techniques and surgical examination.ResultsFifteen patients were studied. The incidence of SEA was 0.4 cases per 100,000 person-years. Infection gained access to the epidural space haematogenously in 9 patients (60%). SEA was located at the lumbar (7 cases), cervical (4), cranial (2) and thoracic (1) areas. Local pain was the most common manifestation (93.3%); fever was absent in 40%. One third did not show neurologic abnormalities. Staphylococcusaureus was the most commonly isolated agent (87% of cases). All the patients received antimicrobial therapy for a mean period of 6.1 ± 3.9 weeks. In addition, open surgical drainage or CT-guided needle aspiration was successfully performed in 10 and 3 patients respectively. Two patients were managed with antibiotics alone. Poor outcome occurred more frequently in patients with abscess at higher levels (67% in cranial or cervical abscesses versus 0% in thoracic or lumbosacral abscesses). An association was found between delayed diagnosis and poor outcome (p < 0.05). Overall, 54% of our patients recovered without sequelae.ConclusionsSEA resulted from the extension of nearby or distant infections into the epidural space. Diagnosis was frequently delayed and the patient's neurologic status at presentation was the most important predictor of the outcome. The onset of spinal pain in patients with focal infections should prompt MRI of the spine, even in the absence of neurologic abnormalities or fever.     

A case of spontaneously recovering multifocal motor neuropathy with conduction blocks (MMNCB) during anti-TNF alpha therapy for ankylosing spondylitis

We report the case of a 54-year-old patient affected by ankylosing spondylitis who developed multifocal motor neuropathy with conduction blocks after 8 months of infliximab treatment. TNF alpha antagonist therapy has been associated with the development of both central nervous system and peripheral nervous system disorders, mainly of the demyelinating type. To our knowledge, this seems to be the second reported case of infliximab-related typical multifocal motor neuropathy with conduction blocks in which no other underlying causes of neuropathy were present. It is also the first in which typical multifocal motor neuropathy with conduction blocks spontaneously recovered without Ig.ev treatment and did not reappear over a long follow-up period. In our opinion, this strengthens the hypothesis of an actual adverse effect of infliximab in this patient. Finally, our case is the first one occurring in a patient with ankylosing spondylitis.     

强直性脊柱炎患者康复护理的研究进展

<正>强直性脊柱炎是以中轴关节受累为主、病因不明确的慢性自身炎症性疾病[1],好发于青壮年,以男性为主,病程长,致残率高,病变常累及外周关节和器官,严重者甚至并发脊柱畸形和关节强直,造成不同程度的功能障碍,严重影响患者的工作和生活[2-3]。强直性脊柱炎目前尚无根治方法,采取适宜的干预措施控制症状、恢复和维持生理功能、延缓疾病进程、降低致残率、提高生活质量是治疗和护理的主要目标[1,4]。国外已有研究[5-6]证实,运动、水疗等干预方式     

骶髂关节磁共振成像在强直性脊柱炎治疗随访中的临床应用

目的 探讨MRI在骶髂关节强直性脊柱炎(AS)患者治疗随访中的作用.方法 对临床确诊的27例AS患者行MR检查,经常规治疗半年后复查骶髂关节MRI,比较软骨线、软骨下骨板、关节旁骨髓水肿、脂肪沉积和关节异常强化的变化,并与临床、实验室检查结果相对照,计算MRI与临床疗效评分在判定AS随访中的敏感度与特异度.结果 27例AS患者治疗前,24例可见软骨线增粗、扭曲、中断;20例见软骨下骨板粗细不均、中断、凹凸不平;26例见关节旁骨髓水肿;15例见脂肪沉积;增强扫描27例均见骨髓内及关节囊、滑膜、关节韧带的异常强化.治疗后20例患者骶髂关节骨髓水肿不同程度减轻;19例患者强化程度减弱或消失.治疗后临床疗效判定为:显效/有效22例,无效5例;而MRI显示治疗显效和(或)有效20例;无效7例.与临床疗效评分比较,MRI诊断AS疗效判定的敏感度为90.91%,特异度为100%.结论 骶髂关节MRI能直观地显示骶髂关节病变转归,在AS治疗随访中有很高的临床应用价值.     

99Tc-亚甲基二膦酸盐的临床应用研究进展

99Tc-亚甲基二瞵酸盐(99Tc-MDP)可以抑制炎性反应,发挥抗炎、抗风湿作用;能抑制前列腺素的合成,具有明显镇痛作用.此外,99Tc-MDP还可通过调节人体自身免疫及调节骨代谢而发挥作用.临床上99Tc-MDP主治类风湿性关节炎、强直性脊柱炎、甲亢伴浸润性突眼等自身免疫性疾病,对癌转移痛、股骨头坏死及骨质疏松也有较好疗效.     

布鲁杆菌性骨关节炎治疗进展

布鲁菌病是一种全球性分布的人畜共患病,可表现为全身多系统损害,其中布鲁杆菌性骨关节炎为布鲁菌病常见的临床表现之一。本文旨在对布鲁杆菌性骨关节炎的治疗进展作一综述。目前国内外文献中报道的治疗方式主要包括药物治疗和手术治疗,其中药物治疗国外普遍试行WHO推荐的药物治疗方案,而我国遵循的为2012年由首都医科大学附属北京地坛医院制定的《布鲁氏菌病诊疗指南（试行）》药物治疗方案,主要包括多西环素、利福平、链霉素类、喹诺酮类和头孢类。对于布鲁杆菌性骨关节炎,早期诊断以及早期、足量、足疗程药物治疗可取得良好的疗效,而对于存在严重脊柱、关节破坏的布鲁杆菌性骨关节炎则应采取手术治疗。     

多层螺旋CT在强直性脊柱炎骶髂关节病变临床诊断中的应用价值

目的研究多层螺旋CT在强直性脊柱炎骶髂关节病变临床诊断中的应用价值。方法选取我院104例患有强直性脊柱炎骶髂关节病变的患者,于规定时间内分别使用x线平片和螺旋CT对所有患者的病变情况进行检查。结果（1）在Ⅰ级和Ⅱ级强直性脊柱炎骶髂关节病变的检出中,多层螺旋CT的检出率高于x线平片,差异有统计学意义（P〈0．05）;对于Ⅲ级和Ⅳ级病变的检出,两者差异则无统计学意义（P〉0．05）。（2）螺旋CT检查出关节面侵蚀、关节面下骨质囊变、骨质增生硬化和软组织肿胀的患者明显多于x线平片,其差异具有统计学意义（P〈0．05）;而对关节间隙狭窄或增宽和关节强直的检查结果进行比较,两者差异均无统计学意义（P〉0．05）。结论在强直性脊柱炎骶髂关节多种病变的检查中,多层螺旋CT都显现出了较高的有效性。     

依那西普联合来氟米特治疗强直性脊柱炎的临床分析

目的 探讨肿瘤坏死因子受体-抗体融合蛋白依那西普(Etanercept)联合来氟米特(LEF)治疗强直性脊柱炎(AS)的临床疗效及应用的安全性.方法 将45例AS患者随机分为3组,每组15例,分别给予依那西普(A组)、依那西普联合来氟米特(B组)和双氯芬酸联合来氟米特(C组)治疗.8周后,A组继续应用依那西普;B组停用依那西普,继续应用来氟米特;C组停用双氯芬酸,继续应用来氟米特.于治疗开始前和治疗后第4周、8周、12周根据患者的临床表现及实验室检查结果,进行临床疗效及安全性评估.结果 3组治疗前临床资料比较,差异均无统计学意义(P＞0.05).治疗后第8周,A、B两组强直性脊柱炎评估(ASAS),ASAS 20和ASAS 50的改善率均高于C组(P＜0.05),而A、B两组的改善率比较,差异均无统计学意义(P＞0.05).治疗后第12周,3组患者ASAS 20的改善率比较,差异无统计学意义(P＞0.05);A、B两组ASAS 50的改善率均高于C组(P＜0.05),而A、B两组改善率比较,差异无统计学意义(P＞0.05).A、B两组的不良反应主要有皮疹、肝功能异常、上呼吸道感染,两组不良反应发生率比较,差异无统计学意义(P＞0.05).C组的不良反应主要有胃肠道反应、肝功能异常,其不良反应发生率高于A、B两组(P＜0.05).结论 应用依那西普治疗AS起效快,且不良反应少.短期应用依那西普联合来氟米特治疗与长期单独应用依那西普疗效相当,不良反应无差异,故可考虑缩短依那西普的疗程,减少患者的经济负担.