|
楼主 |
发表于 2008-12-16 13:32:51
|
显示全部楼层
24-12-第十二节 假痛风
一、病理改变 & x9 `: X1 g: o6 I& m
假痛风病理改变以关节液中焦磷酸盐结晶沉积、透明软骨和纤维软骨钙化为特征。本病常反复发作,且多关节受累,其中以膝关节受累最为多见,耻骨联合、腕、肘、髋关节及椎间盘受累也常见。. K+ Q. u3 I [# I- \4 r
二、X线表现 / p- u) t8 v: v& f) o) A
X线表现主要是:①关节内的透明软骨、纤维软骨关节钙化以及关节周围的滑膜、关节囊、肌腱和韧带钙化;②关节退行性改变。二者可同时或单独出现。
& s3 I* |: S$ t- h0 F1 ^ 纤维软骨受累以膝关节半月板、腕关节的三角软骨、耻骨联合、椎间盘纤维环、髋臼软骨和耳壳软骨等多见;透明软骨则以膝、髋、肩、肘和踝等关节软骨多见。X线所见钙化的特征常为对称性多发性关节内钙化,钙化灶呈线形,且与关节面相平行。膝关节的内侧面及髌股关节面的钙化较为明显(图24一36)。, e: I) D7 i0 B7 M- o- m. B, e
6 o! t$ g& G+ }* {! u: T4 R# h' d9 c7 S$ z- ?# ]+ w
如髌股关节面钙化较重且独立存在时,尽管伴有骨质增生和关节间隙狭窄,也要想到本病的可能性。因本病严重时也可伴有退行性骨关节病的表现,如关节间隙狭窄、关节面硬化和关节边缘骨质增生等,有时可见关节面下囊性变和关节内游离体等改变。另外,本病有时可见到关节囊、滑膜及周围的韧带钙化,偶可见软组织及血管钙化。有时关节的钙化灶很小,需行微焦点放大摄片仔细观察才可见。值得指出的是,许多疾病都可见到关节钙化,如退行性骨关节病、甲状旁腺功能亢进症、血色素沉着、类风湿关节炎及关节外伤等,但这些疾病除有各自疾病本身的特点外,其X线所见的关节软骨钙化不具有本病的对称性和多发性的特点。虽然本病可合并甲状旁腺功能亢进症、褐黄病、糖尿病和肢端肥大症等疾病,但这些病的X线表现与本病X线表现同时出现的并不多见。; ?( B3 o/ H) l
( 余 卫 林 强 )
- R; y8 y. D: H4 S6 P1 x( i 参考文献
# `, t/ m. D; Y/ j5 j' F+ H 曹来宾,张立安,徐爱德等 .强直性脊柱炎临床、实验室及影像学的相关分析与评估.中华放射学杂志,1995.2:95 1 x" f- x' E" c# @" Z+ A1 j
蒋明、余卫、解毓章等 .强直性脊柱炎和类风湿关节炎的临床特点中国康复医学杂志,1991.6:252 5 t L4 d* w7 K" q4 u h
蒋明等.强直性脊柱炎和类风湿关节炎的临床特点 .中国康复医学杂志,1991.6:252 ; q3 J0 U1 |% M5 z+ Z% v
李景学,孙鼎元主编 .骨关节X线诊断学 .北京:人民卫生出版社.1989 唐志学.痛风性关节炎的X线改变中华放射学杂志增刊,1987.38 ; W% ~# R( h8 j2 f* n+ w* [
肖征宇、余卫、张奉春等 男性与女性强直性脊柱炎的临床表现.中华内科杂志,1991.30:646一647
" J: b' _ p4 D& h 阎世昌.100例早期类风湿关节炎的X线观察 .中华放射学杂志,1988.22:154
+ t5 l( w) O% a- M1 ?- |0 B 余卫等.MRI在骨骼肌肉系统中的应用 .国外医学临床放射学分册,1992.15:136 2 o$ }6 `( E4 ]9 o- L, c
余卫等.类风湿关节炎腕关节骨侵蚀改变的CT检查.中华放射学杂志,1992.26:106
$ W/ [- _! s( ?0 Y9 j Boegard T, Jonsson K. Radiography in osteoarthritis of theknee. Skeletal Radiol,1999.28(11);605
( T# D6 o4 |% x Bollow M, Braun J, Biedermann T, et al. Use of contrast-enhanced MR imaging to detect sacroilitis in children. SkeletalRadiol,1998. 27:606 5 H; {, y+ O* K6 H. p( P3 m" P
Gilkson E, et al. Early detection of carpal erosion in patientswith rheumatoid arthritis: a pilot study of magnetic resonanceimaging. J Rheum,1988.15:1361
, l e8 ?7 N5 S. \' m" j) V Helms CA. Arthritis. In: Helms CA. Fundamentals of Skele-tal Radiology. 2nd Ed Philadelphia: W. B. Saunders. 1995. 115一145
& L( B2 r! E4 m$ Z. S HerveSomma CMP, Sebag GH, Prieur AM. Juvenilerheumatoid arthritis of the knee: MR evaluation with Gd-DOTA.Radiology, 1992. 182:93 6 O' i; P9 l9 `" R$ e, h+ y
Mitchell DG et al. Magnetic resonance Imaging of the is-chemic Hip. Clin Orthop,1989. 244:60
5 E3 L- E/ l; s8 e& P/ O2 R Murakami DM, et al. Advances in Imaging of RheumatoidArthritis Clin Orthop,1991.265:83
+ q9 E! j$ m; R8 f- ~ Ostergaard M, Gideon P, Sorensen K, et al. Scoring ofsynovial membrane hypertrophy and bone erosions by MR imagingin clinically active and inactive rheumatoid arthritis of the wrist.Scand J Rheumatol,1995.24:212 2 Z7 ]4 e7 L, A4 i3 @* q: _
Poleksic L, Zdravkovic D, Jablanovic D, et al. Magneticresonance imaging of bone destruction in rheumatoid arthritis:Comparison with radiography. Skeletal Radio1,1993.22(8):577 2 r1 D- V5 h3 f2 L* q& ~
Resnick D. Connective tissue diseases. In: Resnick D. Diagno-sis of Bone and Joint Disorders. 2nd Ed Philadelphia: W. B.Saunders.1988.1266一1363 + Z/ T( g' |8 b x" Q& X8 m7 @0 ]
Resnick D, Niwayama G. Rheumatoid arthritis and relateddiseases. In: Resnick D. Diagnosis of Bone and Joint Disorders.2nd Ed Philadelphia: W. B. Saunders. 1988. 894一1265 7 l0 ?! B/ G- _& U
Stoller DW. Magnetic Resonance Imaging in Orthopaedicsand Rheumatology. Philadephia:lippincott. 1989 6 L- N# X1 @$ z b: E% [
Waldschmidt JG, Braunstein EM, Buckwalter KA. Mag-netic resonance imaging of osteoarthritis. Rheum Dis Clin NorthAm, 1999.25:451 / n7 J O- c& v/ T2 s1 L' P# d
Wei Y, Hsieh YC, Jiang M, et al. CT detection of wristbone erosion in rheumatoid arthritis. Chinese Medical Journal,1993.106:509 & y4 \. T% }1 p2 L5 R7 n7 S
Wei Yu, Feng Feng,.Elizabeth Dion, et al. Comparison ofradiography, computed tomography and magnetic resonanceimaging in the detection of sacroilitis accompanying anklosingspondylitis. Skeletal Radio,l 1998.27:311一320 ) Z' I) b T0 S. ]& \7 K
Weissman BN, Rappoport AS, Sosman JL, et al. Radiograph-is findings in the hands in patients with systemic lupus erythe-matosus. Radiology, 1978.126:313 2 ?6 [" B5 z* O# ?& P- g
Winalski CS, Aliabadi P, Wright RJ. Enhancement of jointfluid with intravenously administered gadopentetate dimeglumine:Technique, rationale, and implications. Radiology, 1993.187:179 # {( W: n+ G: S
Wright V. 1978 Psoriatic arthritis. In Scott JT(ed):Cope-man's Text-book of the Rheumatic Diseases, 5th ed. Edinburgh,Churchill Livingston, 1993. P537 |
|