强直性脊柱炎傅志均VIP专享VIP免费

2011-01-06顺德和平创伤外科医院1骨二区骨二区傅志均傅志均强直性脊柱炎强直性脊柱炎AnkylosingSpondylitisAnkylosingSpondylitis，，ASAS2011-01-06顺德和平创伤外科医院2AnkylosingSpondylitisAnkylosingSpondylitis，，ASAS●Ankylosingspondylitis(AS),isaformofarthritis(关节炎）thatprimarilyaffectsthespine,althoughotherjointscanbecomeinvolved.Itcausesinflammation(炎症)ofthespinaljointsthatcanleadtosevere,chronicpainanddiscomfort.●Inthemostadvancedcases(butnotinallcases),thisinflammationcanleadtonewboneformationonthespine,causingthespinetofuseinafixed,immobileposition,sometimescreatingaforward-stoopedposture.Thisforwardcurvatureofthespineiscalledkyphosis（驼背）.2011-01-06顺德和平创伤外科医院3DescriptionDescription（概况）（概况）●Lowbackpain,withprominentmorningstiffness;improveswithuseandwarmth;sometimesnocturnal(夜间发生的)●Ofteninsidious(潜伏)inonsetinyoungadults●Lossofchestexpansion(胸廓扩张度)asdiseaseprogresses●Associatedwithperipheralarthritis,enthesitis（起止点炎）,andextra-articularmanifestations,suchasiritis(虹膜炎)●Mostfrequentlyfoundinyoungmenunder402011-01-06顺德和平创伤外科医院4Clinicalfinding—SymptomClinicalfinding—Symptom：：●Non-traumaticbackpainandstiffness(僵硬),whichimproveswithactivity●Decreasedrangeofmotioninlumbarspine●Thoraco-cervicalkyphosis(late)●One-thirdofpatientswillhaveacute,unilateraluveitis.（葡萄膜炎）2011-01-06顺德和平创伤外科医院5OtherComplicationsOtherComplications●Pseudoarthrosis(假关节),cervicalspinefracture,C1-C2subluxation,caudaequinasyndrome●Peripheraljointankylosis●Restrictivelungdisease,upperlobefibrosis●Aorticrootdilation(20%)&murmur(2%)2011-01-06顺德和平创伤外科医院6Clinicalfinding—singsClinicalfinding—sings：：●Bilateral(双侧)sacroiliac(骶髂部)tenderness●Adramaticlossofflexibility（柔韧性、灵活性）inthelumbarspineisanearlysign(Schobertest)●Lossofchestexpansion,<2.5cm(normal>5cm),fromdiffusecostovertebralinvolvement●Weightloss(alsoasymptom)2011-01-06顺德和平创伤外科医院7Clinicalfinding—singscontClinicalfinding—singscont：：●Recurrent,acuteiritis(虹膜炎)presentsasapainfulredeye●Neurologicsigns:resultingfromcompressionradiculitis(脊神经根炎)orsciatica（坐骨神经痛）●Anemia●Aorticinsufficiency,angina(咽峡炎),pericarditis（心包炎）2011-01-06顺德和平创伤外科医院8RadiographicFindingsRadiographicFindings●Ankylosis(强直)ofsacroiliacjoints(骶髂关节)●Syndesmophyte(韧带骨赘)inthelumbarspine●Fusionoftheinterspinousligament(棘间韧带)●Arthropathy(关节病)ofbothhips●Enthesopathy(起止点炎)ofischialtuberosity(坐骨结节)2011-01-06顺德和平创伤外科医院9DiagnosisDiagnosis●Familyhistory:oftenoneparenthasAS.●Clinicalfeature:backpain,immobileofjoints,correlativesings●X-ray:AnkylosisSyndesmophyteArthropathyEnthesopathy●Laboratorytests:erythrocytesedimentationrateandC-reactiveproteinelevated2011-01-06顺德和平创伤外科医院10MedicalTreatmentMedicalTreatment●Non-steroidalanti-inflammatorydrugs（NSADs）canrapidlyreducethesignsandsymptoms●Sulfasalazine(柳氮磺胺吡啶)hasnoclinicallyeffectiveforAS;however,severalstudiessuggestthatitmaybeeffectiveforperipheralarthritisassociatedwithAS●Methotrexate(甲氨蝶呤)hasnotbeenshowntobeeffectiveinclinicaltrialsforeithertheaxialorappendicularmanifestationsofAS2011-01-06顺德和平创伤外科医院11SurgicalTreatmentSurgicalTreatmentJointreplacementsurgeryandspinesurgeryshouldbeconsideredinpatientswithrefract...