经椎弓根截骨术治疗强直性脊柱炎继发颈胸段后凸畸形

目的评估后路经椎弓根截骨术(PSO)治疗强直性脊柱炎(AS)继发颈胸段后凸畸形的临床疗效。方法2009年1月—2015年3月,本院采用PSO治疗AS继发颈胸段后凸畸形患者7例。患者翻身至手术床之前,先放置石膏床于患者腹侧,并在患者颈胸段与石膏床的空隙处填充数个长方形棉垫。术中C6~T1后方截骨及经C7椎弓根椎体截骨完成后,由台下助手缓慢逐个抽取垫于患者和石膏床之间的长方形棉垫。待棉垫抽取完毕后,患者颈胸段的曲度在重力的作用下恢复至近似直线。然后采用体内弯棒技术进一步增加颈胸段前凸曲度。记录手术时间及术中出血量,用颈胸段(C_2~T_1)后凸Cobb角、颏眉角(CBVA)、C_2~T_1矢状面偏移距离(SVA)、疼痛视觉模拟量表(VAS)和健康调查量表(SF-36)评估临床疗效。结果 7例患者平均手术时间260 min,术中平均出血量1 571 m L,平均随访24.4个月,术前C_2~T_1 Cobb角平均为26.2°,末次随访时为-5.4°。术前CVBA平均为43.1°,术后改善至-0.9°。术前C_2~T_1 SVA平均为6.7 cm,术后改善至3.0 cm。末次随访时,患者的VAS评分由术前的85.0分改善至17.1分;SF-36躯体机能评分(PCS)由术前的20.7分改善至79.3分;SF-36精神机能评分(MCS)由术前的12.8分改善至81.6分。结论 PSO治疗AS继发颈胸段后凸畸形可以有效地恢复颈胸段的矢状位平衡,较好地改善患者前方视野受限、颏-胸畸形等症状,采用术中体内原位弯棒技术安全可靠。     

强直性脊柱炎I期双侧人工全髋关节置换术

目的观察强直性脊柱炎同期行双侧人工全髋关节置换术的疗效。方法自2008-05—2011-05对6例强直性脊柱炎患者行双侧人工全髋关节置换术,男5例,女1例;年龄31～42岁,平均37岁;术前双髋关节骨性强直,活动度0度,5例髋关节屈曲挛缩。结果术后6例均获得随访,随访时间6个月～3 a,平均27个月,无关节脱位、感染、松动、深静脉栓塞等并发症发生;Harris评分优良率为83.3%。结论强直性脊柱炎双侧髋关节完全强直,行同期双侧人工髋关节置换有利于患者功能恢复,提高生活质量。     

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。     

化痰活血方穴位贴敷联合西药治疗强直性脊柱炎晨僵43例

目的通过比较化痰活血方穴位贴敷联合西药与单纯西药对强直性脊柱炎晨僵的临床疗效差异,评价其对强直性脊柱炎晨僵的疗效及安全性。方法将80例强直性脊柱炎的患者随机分为两组,治疗组43例采用化痰活血方穴位贴敷联合西药治疗,对照组37例运用单纯西药治疗,比较治疗前后患者的晨僵时间、BASDAI以及观察在治疗期间不良反应情况,以评价其有效性、安全性,并对上述结果进行统计学处理。结果①两组患者治疗前后组内比较,患者的晨僵时间、BASDAI评分差异显著（P〈0.05）。②两组患者在治疗后晨僵时间、BASDAI积分对比,经统计学处理,在晨僵时间、BASDAI比较中具有统计学意义（P〈0.05）,说明化痰活血方穴位贴敷联合西药缩短晨僵时间上具有优于单纯西药的作用;治疗组总有效率81.4%,对照组总有效率59.5%,经统计学处理,两组临床疗效经卡方检验,具有统计学意义,差异显著（P〈0.05）。结论化痰活血方穴位贴敷联合西药能明显有效、安全地缓解强直性脊柱炎患者的晨僵。     

强直性脊柱炎X线、CT、MRI特异性影像学分析

目的 探讨分析强直性脊柱炎(AS)各期特异性影像学特征,为诊断和治疗该病提供科学依据.方法 回顾调查我院近几年收治的强直性脊柱炎病例的影像学特征,分析强直性脊柱炎影像学特点.结果 患者以腰骶疼痛、晨僵等为主要症状.强直性脊柱炎骶髂关节CT表现示病变主要累及骶髂关节滑膜部的髂骨侧,骶髂关节变毛糙、模糊、受侵蚀出现率最高.双侧X线检查16例AS中,Ⅰ级2例,Ⅱ级5例,Ⅲ级7例,Ⅳ级2例.16例均有骶髂关节变毛糙、模糊、关节变窄等征象.平扫CT显示16例,≥Ⅱ级14例中骶髂关节异常,即骶髂关节变毛糙、模糊、受侵蚀,病变局限于一侧3例,占18.75%;双侧不对称者6例,占37.5%;5例关节出现硬化,占31.25%,其中2例双侧硬化程度不一致,占12.5%;3例关节融合,占18.75%;另同时合并关节变窄者6例,占37.5%,2例仅有左侧关节间隙变窄,右侧正常.CT不足Ⅱ级者,进行MRI检查.本组中Ⅰ级2例,采用MRI扫描均可见骶髂关节周围骨髓信号不同程度异常,1例于T1WI呈现低信号,为不均匀减低和连续性碎裂现象;1例压脂T2WI及STIR呈现高信号、不规则增厚,该例临床表现软骨破坏、关节旁水肿和广泛脂肪沉积.结论 通过X射线、CT和MRI检查对诊断强直性脊柱炎具有重要意义.     

The prevalence and impact of comorbid fibromyalgia in inflammatory arthritis

Fibromyalgia (FM) is one of the most common conditions that rheumatologists encounter. It is characterised by chronic widespread pain, fatigue, sleep disturbances and impaired cognition. The prevalence of comorbid FM among populations with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) are considerably higher than among the general population, with pooled prevalence estimates of 18–24% in RA, 14–16% in axSpA and 18% in PsA. Prevalence estimates should be interpreted with care as the criteria for FM have not been validated for use in patients with inflammatory arthritis. Comorbid FM appears to affect assessment of disease severity in these conditions, particularly patient-reported outcome measures, and may influence response to treatment. There is a need for better identification, classification and management of FM in the context of inflammatory rheumatic diseases.     

强直性脊柱炎患者血清IFN一百的变化

为探讨免疫调节异常在强直性脊柱炎(AS)发病机制中所起的作用,采用酶联免疫法(ELISA)检测35例AS患者的血清IFN—γ百含量,并以30例健康体检者为正常对照。结果显示AS患者血清IFN—γ(33.16±12.23pg/mL)明显低于正常对照组(55.16±30.75pg/mL),差异有显著性意义(P<0.01)。提示T淋巴细胞功能异常可能参与AS的发病过程。     

Erector spinae SEMG activity during forward flexion and re-extension in ankylosing spondylitis patients

Objective: To compare erector spinae muscle (ESM) activity as measured by surface electromyography (SEMG) in lumbar flexion from the upright position in men with ankylosing spondylitis (AS) and healthy males, and to study associations between pain, lumbar mobility and ESM activity. Methods: Surface EMG was undertaken at the L1-2 and L4-5 levels in 11 men with AS taking part in a rehabilitation course at the Rheumatism Foundation Hospital, and in 10 pain-free male controls, while the subjects were bending forward. Results: During full flexion ESM SEMG activity was significantly greater in patients with AS than in the controls. Relaxation was evident during flexion in all of the controls but in only some patients with AS. Lumbar mobility correlated negatively with ESM activities. No relationship between pain and ESM activity was evident. Some AS patients reported pain while ESM activity was being measured. Conclusion: Decreased lumbar mobility rather than pain explains ESM activity during full flexion in patients with AS.     

Clustering of organ-specific autoimmunity: a case presentation of multiple sclerosis and connective tissue disorders

Multiple sclerosis (MS) is the most common demyelinating disease caused by an autoimmune inflammatory process in the central nervous system (CNS) and is associated with aberrant immune response to myelin selfantigens. Coexistence of MS with other autoimmune disorders, including connective tissue disorders including systemic lupus erythematosus, rheumatoid arthritis, Sjögren’s syndrome and scleroderma have been reported previously. In the present article we report the coexistence of MS, familial mediterranean fever and ankylosing spondylitis in a patient and review the clinical presentation, neurologic findings, cerebrospinal fluid and radiologic characteristics and treatment options. We further discuss the immunopathogenetic mechanisms for a possible association between MS and autoimmune disorders.     

The Cauda Equina Syndrome: A Rare Extra-Articular Manifestation of Ankylosing Spondylitis: A Case Report

A patient with long standing ankylosing spondylitis later developed a rare complication, the cauda equina syndrome, and associated lumbar thecal diverticulae. The pathogenesis of this condition and its investigation using radiological techniques are discussed.