强直性脊柱炎累及双髋关节.ppt

Case Disscusion,By Group Group 2013-07-11,2011-06-02,History,Male,28 years oldHip painNo laboratory examination,Final Diagnosis,bilateral sacroiliitis seronegative spondyloarthropathy involve bilatreal hip jointsynovial cyst at the front margin of articular,AS,mainly young adults,mostly male age:10 to 40 years old,average 25hip involvedone-third of patients with ASHLA-B27 positive 90%axial skeletal:bilaterallyperipheral arthritis:asymmetrically,AS,conventional radiographstwo typical featuresconcentric osteoproliferation with osteophytes around the femoral neckerosions of the acetabulum,AS,conventional radiographsotherssclerosissynovitis;enthesitisosteophytosis joint space narrowing concentric,uniform joint effusionsubchondral bone marrow edema periarticular fat depositions,DDX,Rheumatoid arthritis(RA)Tuberculosis(TB),RA,autoimmune disorder of unknown etiologycharacteristicsymmetricerosive synovitissometimes multisystem involvementhip involved5to15%mainly women,RA,clinical symptompainswellingstiffness motion impairmentlaboratory testsrheumatoid factor(+)elevated ESR and CRP,RA,imaging appearancesynovitisthickening of soft tissue osteoporosissubchondral cyst formationhomogeneous narrowing of articular spaceerosion of cartilageacetabulum and head of femur both involved,RA,imaging appearanceMRIearly stage(rich vessels of pannus)T1WIlow signalT2WIhigh signallate stage(increased fabre composition)T1WIisosignalT2WIisosignal,RA,synovial cystrare,TB,pathogenesis hematogenous dissemination15%cases of osteoarticular tuberculosiscommon agethe second and third decadesthe most common sitevertebral tuberculosis,TB,lesions on the acetabular side progress less rapidly than lesions on the femoral side,TB,clinical 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,imaging appearancethickening of the synoviumsubchondral and marginal bony erosion effusionloss of joint spaceperiarticular abscessjuxta-articular osteoporosis,TB,hip dislocation uncommon,TB,tuberculous bursitisrarecommon sitetrochanteric region,hip joint arthritis,clinical symptom、agegender、laboratory examination,HLA-27(+),AS,RF(+),RA,Tubercle bacillus,TB,imaging appearance,enthesitis、osteophytosis、combined SIJ and spine changes,AS,obvious synovitis,polyarticular、bone erosion、uniform narrowing,RA,monoarticularnonuniform narrowing bone destruction,TB,Final diagnosis,combination,Made by chaichao,