肌肉骨骼系統(tǒng)關(guān)節(jié)炎

肌肉骨骼系統(tǒng)關(guān)節(jié)炎AnatomyABC關(guān)節(jié)炎arthritisDefinition定義－－－Diseasethataffectsbonesonbothsidesofthejointspaceand－－－NarrowsthespaceinbetweenthemArthritisorNotAVNDJDABCPVNSClassification分類增生性HypertrophicBoneproductionSclerosis感染性InfectiousDestructionofarticularcortex侵蝕性ErosiveErosions增生性關(guān)節(jié)炎HypertrophicArthritis退行性關(guān)節(jié)炎DegenerativearthritisPrimarySecondaryCharcotarthropathy（夏科氏關(guān)節(jié)）PrimaryDegenerativeArthritis

原發(fā)性退行性關(guān)節(jié)炎（掌握）關(guān)節(jié)軟骨內(nèi)部退變IntrinsicdegenerationofarticularcartilageExcessivewearandtearMostcommonlyhipsandkneesLesscommonlyshouldersandelbowsPrimaryDegenerativeArthritis

診斷要點(diǎn)X-rayFindings間隙變窄Narrowingofjointspace軟骨下硬化Subchondralsclerosis邊緣骨贅形成Marginalosteophyteformation軟骨下囊腫SubchondralcystsPrimaryDJDofkneesaffectsmedial,weight-bearingsurfacePrimaryDJDofhipsaffectssuperior,weight-bearingsurfacePrimaryDJDofkneesSecondaryDegenerativeArthritis

繼發(fā)性退行性關(guān)節(jié)炎（了解）AnotherprocessdestroysarticularcartilageDegenerativechangessuperveneHowtorecognizeAtypicallocations(CPPDandknee)Atypicalappearance(MarkedDJDof1hip)Atypicalage(DJDin20year-old)SecondaryDegenerativeArthritis

MoreCausesTrauma創(chuàng)傷Infection感染Avascularnecrosis骨壞死RA類風(fēng)濕Hemophilia血友病Bottomline:AnyarthritiscanendasDJDABCClassificationHypertrophicBoneproductionSclerosisInfectiousDestructionofarticularcortexErosiveErosionsInfectiousArthritis（掌握）Causes：

Usuallystaph，TBMorecommoninadultsUsuallyfromlocaltrauma-surgeryoraccidentChildrengetosteomyelitisDestructionofarticularcartilage&cortexTendstoaffectonejointpyogenicarthritis化膿性關(guān)節(jié)炎感染途徑：1、2、3病理：滑膜炎癥－－軟骨溶解，骨質(zhì)破壞－－肉芽組織進(jìn)入－－纖維或骨性強(qiáng)直。診斷要點(diǎn)起病急，癥狀重關(guān)節(jié)間隙變窄:早期出現(xiàn)骨質(zhì)破壞:承重面，廣泛骨質(zhì)增生：?關(guān)節(jié)強(qiáng)直:晚期出現(xiàn)。SepticarthritisoftoeTuberculosisofjoint關(guān)節(jié)結(jié)核

診斷要點(diǎn)慢性起病骨質(zhì)破壞:邊緣為主關(guān)節(jié)間隙變窄:出現(xiàn)晚且程度輕關(guān)節(jié)囊腫脹，鄰近骨骼和肌肉明顯骨質(zhì)疏松和萎縮。起病急，癥狀重骨質(zhì)破壞:承重面，廣泛關(guān)節(jié)間隙變窄:早期出現(xiàn)骨質(zhì)增生：?關(guān)節(jié)強(qiáng)直:晚期出現(xiàn)。pyogenicarthritis化膿性關(guān)節(jié)炎診斷要點(diǎn)TBNormalhipAcetabularwhitelineClassification

ErosiveArthritisHypertrophicBoneproductionSclerosisInfectiousDestructionofarticularcortexErosiveErosionsErosiveArthritis

GeneralSynovialproliferation(pannusformation血管翳)InflammationErosionsseeninsmalljoints(hands)betterthanlarge(hips)DestroyportionofcortexErosiveArthritis

TypesRheumatoidarthritis（掌握）GoutHemophiliaErosiveosteoarthritisRheumatoidvariantsPsoriaticarthritisReiter'sAnkylosingspondylitis（了解）InflammatoryboweldiseaseRheumatoidArthritis診斷要點(diǎn)中年女性雙側(cè)對稱發(fā)病Bilaterallysymmetrical常累及手部小關(guān)節(jié)Earliestchange:STSMCP,PIP,ulnarstyloid關(guān)節(jié)軟組織梭形腫脹關(guān)節(jié)邊緣出現(xiàn)侵蝕性骨破壞，骨性關(guān)節(jié)面模糊，中斷或骨質(zhì)吸收囊變鄰近骨骼骨質(zhì)疏松關(guān)節(jié)變窄，關(guān)節(jié)面增生硬化少骨骼畸形病變演變示意圖關(guān)節(jié)梭形腫脹，間隙增寬關(guān)節(jié)邊緣侵蝕性骨破壞間隙變窄，邊緣和關(guān)節(jié)面破壞，假囊腫形成關(guān)節(jié)強(qiáng)直ABABAnkylosingSpondylitis

強(qiáng)直性脊柱炎（了解）HLA-B27positiveSIarthritisSquaringofvertebralbodies（方性椎）Ba