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24-12-第十二节 假痛风
一、病理改变
6 }" n: Q8 X* b0 c7 O% ` 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。% ^$ h g, K; c$ q
二、X线表现 ' i: J/ G5 K% { X* N
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。
" i1 S/ K! i7 G' b( e( v, A 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)。, D4 S2 f* }- [
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# k7 R$ Z* d: F0 T; V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。
- V% a- i1 e9 ~; _ ( 余 卫 林 强 )# x; C% S( O* g6 U1 X7 ~# ]
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