強(qiáng)直性脊柱炎累及雙髖關(guān)節(jié)課件

1、Case DisscusionBy Group Group 2013-07-112011-06-02History Male, 28 years oldHip painNo laboratory examination Final Diagnosisbilateral sacroiliitis seronegative spondyloarthropathy involve bilatreal hip jointsynovial cyst at the front margin of articular ASmainly young adults, mostly male age:10 to

2、40 years old, average 25hip involvedone-third of patients with ASHLA-B27 positive 90% axial skeletal : bilaterallyperipheral arthritis :asymmetrically ASconventional radiographstwo typical featuresconcentric osteoproliferation with osteophytes around the femoral neckerosions of the acetabulum ASconv

3、entional radiographsotherssclerosissynovitis ; enthesitisosteophytosis joint space narrowing concentric ,uniform joint effusionsubchondral bone marrow edema periarticular fat depositions DDXRheumatoid arthritis (RA)Tuberculosis (TB) RAclinical symptompainswellingstiffness motion impairmentlaboratory

4、 testsrheumatoid factor(+)elevated ESR and CRP RAimaging appearancesynovitisthickening of soft tissue osteoporosissubchondral cyst formationhomogeneous narrowing of articular spaceerosion of cartilageacetabulum and head of femur both involved RAimaging appearanceMRIearly stage (rich vessels of pannu

5、s)T1WIlow signalT2WIhigh signallate stage (increased fabre composition)T1WIisosignalT2WIisosignal RAsynovial cystrare TBpathogenesis hematogenous dissemination15% cases of osteoarticular tuberculosiscommon agethe second and third decadesthe most common sitevertebral tuberculosis TBlesions on the ace

6、tabular side progress less rapidly than lesions on the femoral side TBclinical symptomcommon symptomjoint symptompainfixed deformities of the hippainful limitation of movementmuscle wastingregional lymph node enlargementform of cold abscess with or without sinusespathologic dislocation of the hip TB

7、imaging appearancethickening of the synoviumsubchondral and marginal bony erosion effusionloss of joint spaceperiarticular abscessjuxta-articular osteoporosis TBhip dislocation uncommon TBtuberculous bursitisrarecommon sitetrochanteric regionhip joint arthritisclinical symptom、agegender、laboratory e

8、xaminationHLA-27(+)ASRF(+)RATubercle bacillus TBimaging appearanceenthesitis、osteophytosis、combined SIJ and spine changesASobvious synovitispolyarticular、bone erosion、uniform narrowingRAmonoarticularnonuniform narrowing bone destructionTBFinal diagnosiscombinationThank You !Made by chaichaoRAJoint TBPVNSGouty Joint involvementPolyarticularSymmetricalmonoarticularmonoarticularKnee，80%The first metatarsophalangeal jointsequestrum_+_co