强直性脊柱炎累及双髋关节VIP免费

CaseDisscusionByGroupGroup2013-07-112011-06-02HistoryMale,28yearsoldHippainNolaboratoryexaminationFinalDiagnosisbilateralsacroiliitisseronegativespondyloarthropathyinvolvebilatrealhipjointsynovialcystatthefrontmarginofarticularASmainlyyoungadults,mostlymaleage:10to40yearsold,average25hipinvolved——one-thirdofpatientswithASHLA-B27positive>90%axialskeletal:bilaterallyperipheralarthritis:asymmetricallyASconventionalradiographstwotypicalfeaturesconcentricosteoproliferationwithosteophytesaroundthefemoralneckerosionsoftheacetabulumASconventionalradiographsotherssclerosissynovitis;enthesitisosteophytosisjointspacenarrowing——concentric,uniformjointeffusionsubchondralbonemarrowedemaperiarticularfatdepositionsDDXRheumatoidarthritis(RA)Tuberculosis(TB)RAautoimmunedisorderofunknownetiologycharacteristicsymmetricerosivesynovitissometimesmultisysteminvolvementhipinvolved——5to15%mainlywomenRAclinicalsymptompainswellingstiffnessmotionimpairmentlaboratorytestsrheumatoidfactor(+)elevatedESRandCRPRAimagingappearancesynovitisthickeningofsofttissueosteoporosissubchondralcystformationhomogeneousnarrowingofarticularspaceerosionofcartilageacetabulumandheadoffemurbothinvolvedRAimagingappearanceMRIearlystage(richvesselsofpannus)T1WI——lowsignalT2WI——highsignallatestage(increasedfabrecomposition)T1WI——isosignalT2WI——isosignalRAsynovialcyst——rareTBpathogenesis—hematogenousdissemination15%casesofosteoarticulartuberculosiscommonage——thesecondandthirddecadesthemostcommonsite——vertebraltuberculosisTBlesionsontheacetabularsideprogresslessrapidlythanlesionsonthefemoralsideTBclinicalsymptomcommonsymptomjointsymptompainfixeddeformitiesofthehippainfullimitationofmovementmusclewastingregionallymphnodeenlargementformofcoldabscesswithorwithoutsinusespathologicdislocationofthehipTBimagingappearancethickeningofthesynoviumsubchondralandmarginalbonyerosioneffusionlossofjointspaceperiarticularabscessjuxta-articularosteoporosisTBhipdislocation——uncommonTBtuberculousbursitis——rarecommonsite——trochantericregionhipjointarthritisclinicalsymptom、agegender、laboratoryexaminationHLA-27(+)ASRF(+)RATuberclebacillusTBimagingappearanceenthesitis、osteophytosis、combinedSIJandspinechangesASobvioussynovitispolyarticular、boneerosion、uniformnarrowingRAmonoarticularnonuniformnarrowingbonedestructionTBFinaldiagnosiscombinationMadebychaichaoRAJointTBPVNSGoutyJointinvolvementPolyarticularSymmetricalmonoarticularmonoarticularKnee，80%Thefirstmetatarsophalangealjointsequestrum_+__coldabscess/sinustract_+__Reactivesclerosis_+_+OsteoporosiswideLocal(Periarticular)__jointspacenarrowinguniformnonuniform_（late）_