肌肉骨骼系统关节炎

肌肉骨骼系统关节炎AnatomyABC关节炎arthritisDefinition定义－－－Diseasethataffectsbonesonbothsidesofthejointspaceand－－－NarrowsthespaceinbetweenthemArthritisorNotAVNDJDABCPVNSClassification分类增生性HypertrophicBoneproductionSclerosis感染性InfectiousDestructionofarticularcortex侵蚀性ErosiveErosions增生性关节炎HypertrophicArthritis退行性关节炎DegenerativearthritisPrimarySecondaryCharcotarthropathy（夏科氏关节）PrimaryDegenerativeArthritis

原发性退行性关节炎（掌握）关节软骨内部退变IntrinsicdegenerationofarticularcartilageExcessivewearandtearMostcommonlyhipsandkneesLesscommonlyshouldersandelbowsPrimaryDegenerativeArthritis

诊断要点X-rayFindings间隙变窄Narrowingofjointspace软骨下硬化Subchondralsclerosis边缘骨赘形成Marginalosteophyteformation软骨下囊肿SubchondralcystsPrimaryDJDofkneesaffectsmedial,weight-bearingsurfacePrimaryDJDofhipsaffectssuperior,weight-bearingsurfacePrimaryDJDofkneesSecondaryDegenerativeArthritis

继发性退行性关节炎（了解）AnotherprocessdestroysarticularcartilageDegenerativechangessuperveneHowtorecognizeAtypicallocations(CPPDandknee)Atypicalappearance(MarkedDJDof1hip)Atypicalage(DJDin20year-old)SecondaryDegenerativeArthritis

MoreCausesTrauma创伤Infection感染Avascularnecrosis骨坏死RA类风湿Hemophilia血友病Bottomline:AnyarthritiscanendasDJDABCClassificationHypertrophicBoneproductionSclerosisInfectiousDestructionofarticularcortexErosiveErosionsInfectiousArthritis（掌握）Causes：

Usuallystaph，TBMorecommoninadultsUsuallyfromlocaltrauma-surgeryoraccidentChildrengetosteomyelitisDestructionofarticularcartilage&cortexTendstoaffectonejointpyogenicarthritis化脓性关节炎感染途径：1、2、3病理：滑膜炎症－－软骨溶解，骨质破坏－－肉芽组织进入－－纤维或骨性强直。诊断要点起病急，症状重关节间隙变窄:早期出现骨质破坏:承重面，广泛骨质增生：?关节强直:晚期出现。SepticarthritisoftoeTuberculosisofjoint关节结核

诊断要点慢性起病骨质破坏:边缘为主关节间隙变窄:出现晚且程度轻关节囊肿胀，邻近骨骼和肌肉明显骨质疏松和萎缩。起病急，症状重骨质破坏:承重面，广泛关节间隙变窄:早期出现骨质增生：?关节强直:晚期出现。pyogenicarthritis化脓性关节炎诊断要点TBNormalhipAcetabularwhitelineClassification

ErosiveArthritisHypertrophicBoneproductionSclerosisInfectiousDestructionofarticularcortexErosiveErosionsErosiveArthritis

GeneralSynovialproliferation(pannusformation血管翳)InflammationErosionsseeninsmalljoints(hands)betterthanlarge(hips)DestroyportionofcortexErosiveArthritis

TypesRheumatoidarthritis（掌握）GoutHemophiliaErosiveosteoarthritisRheumatoidvariantsPsoriaticarthritisReiter'sAnkylosingspondylitis（了解）InflammatoryboweldiseaseRheumatoidArthritis诊断要点中年女性双侧对称发病Bilaterallysymmetrical常累及手部小关节Earliestchange:STSMCP,PIP,ulnarstyloid关节软组织梭形肿胀关节边缘出现侵蚀性骨破坏，骨性关节面模糊，中断或骨质吸收囊变邻近骨骼骨质疏松关节变窄，关节面增生硬化少骨骼畸形病变演变示意图关节梭形肿胀，间隙增宽关节边缘侵蚀性骨破坏间隙变窄，边缘和关节面破坏，假囊肿形成关节强直ABABAnkylosingSpondylitis

强直性脊柱炎（了解）HLA-B27positiveSIarthritisSquaringofvertebralbodies（方性椎）Ba