强直性脊柱炎累及双髋关节

强直性脊柱炎累及双髋关节第1页/共57页HistoryMale,28yearsoldHippainNolaboratoryexamination第2页/共57页第3页/共57页第4页/共57页第5页/共57页第6页/共57页第7页/共57页第8页/共57页第9页/共57页第10页/共57页第11页/共57页第12页/共57页第13页/共57页FinalDiagnosisbilateralsacroiliitisseronegativespondyloarthropathyinvolvebilatrealhipjointsynovialcystatthefrontmarginofarticular第14页/共57页ASmainlyyoungadults,mostlymaleage:10to40yearsold,average25hipinvolved——one-thirdofpatientswithASHLA-B27positive>90%axialskeletal:bilaterallyperipheralarthritis:asymmetrically第15页/共57页ASconventionalradiographstwotypicalfeaturesconcentricosteoproliferationwithosteophytesaroundthefemoralneckerosionsoftheacetabulum第16页/共57页第17页/共57页ASconventionalradiographsotherssclerosissynovitis;enthesitisosteophytosisjointspacenarrowing——concentric,uniformjointeffusionsubchondralbonemarrowedemaperiarticularfatdepositions第18页/共57页第19页/共57页第20页/共57页第21页/共57页第22页/共57页第23页/共57页DDXRheumatoidarthritis(RA)Tuberculosis(TB)第24页/共57页RAautoimmunedisorderofunknownetiologycharacteristicsymmetricerosivesynovitissometimesmultisysteminvolvementhipinvolved——5to15%mainlywomen第25页/共57页RAclinicalsymptompainswellingstiffnessmotionimpairmentlaboratorytestsrheumatoidfactor(+)elevatedESRandCRP第26页/共57页RAimagingappearancesynovitisthickeningofsofttissueosteoporosissubchondralcystformationhomogeneousnarrowingofarticularspaceerosionofcartilageacetabulumandheadoffemurbothinvolved第27页/共57页RAimagingappearanceMRIearlystage(richvesselsofpannus)T1WI——lowsignalT2WI——highsignallatestage(increasedfabrecomposition)T1WI——isosignalT2WI——isosignal第28页/共57页

第29页/共57页RAsynovialcyst——rare第30页/共57页第31页/共57页第32页/共57页TBpathogenesis—hematogenousdissemination15%casesofosteoarticulartuberculosiscommonage——thesecondandthirddecadesthemostcommonsite——vertebraltuberculosis第33页/共57页TBlesionsontheacetabularsideprogresslessrapidlythanlesionsonthefemoralside第34页/共57页TBclinicalsymptomcommonsymptomjointsymptompainfixeddeformitiesofthehippainfullimitationofmovementmusclewastingregionallymphnodeenlargementformofcoldabscesswithorwithoutsinusespathologicdislocationofthehip第35页/共57页第36页/共57页TBimagingappearancethickeningofthesynoviumsubchondralandmarginalbonyerosioneffusionlossofjointspaceperiarticularabscessjuxta-articularosteoporosis第37页/共57页第38页/共57页第39页/共57页第40页/共57页第41页/共57页第42页/共57页第43页/共57页第44页/共57页第45页/共57页第46页/共57页第47页/共57页TBhipdislocation——uncommon第48页/共57页第49页/共57页TBtuberculousbursitis——rarecommonsite——trochantericregion第50页/共57页第51页/共57页第52页/共57页hipjointarthritisclinicalsymptom、agegender、laboratoryexaminationHLA-27(+)ASRF(+)RATuberclebacillus

TBimagingappearanceenthesitis、osteophytosis、combinedSIJandspinechangesASobvioussynovitispolyarticular、boneerosion、uniformnarrowingRAmonoarticularnonuniformnarrowingbonedestructionTBFinaldiagnosiscombination第53页/共57页ThankYou!Madebychaichao第54页/共57页RA

JointTBPVNSGoutyJointinvolvementPolyarticularSymmetricalmonoarticularmonoarticularKnee，80%Thefirstmetatarsophalangealjointsequestrum_+__