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1、Case DisscusionBy Group Group 2013-07-112011-06-02强直性脊柱炎累及双髋关节History nMale, 28 years oldnHip painnNo laboratory examination强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节 Final Diagnosisnbilateral sacro
2、iliitis nseronegative spondyloarthropathy involve bilatreal hip jointnsynovial cyst at the front margin of articular 强直性脊柱炎累及双髋关节 ASnmainly young adults, mostly male nage:10 to 40 years old, average 25nhip involvedone-third of patients with ASnHLA-B27 positive 90% naxial skeletal : bilaterallynperip
3、heral arthritis :asymmetrically强直性脊柱炎累及双髋关节 ASnconventional radiographsntwo typical featuresnconcentric osteoproliferation with osteophytes around the femoral necknerosions of the acetabulum强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节 ASnconventional radiographsnothersnsclerosisnsynovitis ; enthesitisnosteophytosis njo
4、int space narrowing concentric ,uniform njoint effusionnsubchondral bone marrow edema nperiarticular fat depositions 强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节 DDXnRheumatoid arthritis (RA)nTuberculosis (TB)强直性脊柱炎累及双髋关节 RAnautoimmune disorder of unknown etiologyncharact
5、eristicnsymmetricnerosive synovitisnsometimes multisystem involvementnhip involved5to15%nmainly women强直性脊柱炎累及双髋关节 RAnclinical symptomnpainnswellingnstiffness nmotion impairmentnlaboratory testsnrheumatoid factor(+)nelevated ESR and CRP强直性脊柱炎累及双髋关节 RAnimaging appearancensynovitisnthickening of soft t
6、issue nosteoporosisnsubchondral cyst formationnhomogeneous narrowing of articular spacenerosion of cartilagenacetabulum and head of femur both involved强直性脊柱炎累及双髋关节 RAnimaging appearancenMRInearly stage (rich vessels of pannus)nT1WIlow signalnT2WIhigh signalnlate stage (increased fabre composition)nT
7、1WIisosignalnT2WIisosignal强直性脊柱炎累及双髋关节 强直性脊柱炎累及双髋关节 RAnsynovial cystrare强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节 TBnpathogenesis hematogenous disseminationn15% cases of osteoarticular tuberculosisncommon agethe second and third decadesnthe most common sitevertebral tuberculosis强直性脊柱炎累及双髋关节 TBnlesions on
8、 the acetabular side progress less rapidly than lesions on the femoral side强直性脊柱炎累及双髋关节 TBnclinical symptomncommon symptomnjoint symptomnpainnfixed deformities of the hipnpainful limitation of movementnmuscle wastingnregional lymph node enlargementnform of cold abscess with or without sinusesnpathol
9、ogic dislocation of the hip强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节 TBnimaging appearancenthickening of the synoviumnsubchondral and marginal bony erosion neffusionnloss of joint spacenperiarticular abscessnjuxta-articular osteoporosis强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双
10、髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节 TBnhip dislocation uncommon强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节 TBntuberculous bursitisrarencommon sitetrochanteric region强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节hip joint arthritisclinical symptom、agegender、laboratory examinationHLA-27(+)ASRF(+)RATubercle bacillu
11、s TBimaging appearanceenthesitis、osteophytosis、combined SIJ and spine changesASobvious synovitispolyarticular、bone erosion、uniform narrowingRAmonoarticularnonuniform narrowing bone destructionTBFinal diagnosiscombination强直性脊柱炎累及双髋关节Made by chaichao强直性脊柱炎累及双髋关节RAJoint TBPVNSGouty Joint involvementPolyarticularSymmetricalmonoarticularmonoarticularKnee，80%The first metatarsophalangeal jointsequestrum_+_cold abscess /sinus tract _+_Reactive sclerosis_+_+OsteoporosiswideLocal(Periarticular )_joint space narrowinguniformnonuniform_（late）_强直性脊柱炎累及双髋关节强直性脊柱炎累及双髋关节
