1Spine CenterBethune hospitalJilin University 强直性脊柱炎简介刘理迪 2010-5-14 2Spine CenterBethune hospitalJilin Universityl强直性脊柱炎（ankylosing spondylitis）l一种慢性进行性炎性疾病l主要累及骶髂关节、脊柱等中轴关节l类风湿因子（RF）阴性l90%以上HLA-B27阳性 3Spine CenterBethune hospitalJilin Universityl病理改变：l脊柱、骶髂关节的慢性反复性、非特异性炎症l以关节囊、肌腱、韧带附着点炎为特点l淋巴、浆细胞浸润—附着点炎症—骨膜炎—肉芽肿—钙化—新骨形成—韧带骨化—骨桥/骨板—关节强直 4Spine CenterBethune hospitalJilin Universityl受累部位l骶髂关节：l最早 5Spine CenterBethune hospitalJilin University 6Spine CenterBethune hospitalJilin University 7Spine CenterBethune hospitalJilin Universityl临床表现l1、男性多见，且比女性症状典型。
3-5：1l2、起病缓慢l3、发病年龄：10-40岁 8Spine CenterBethune hospitalJilin Universityl1、早期可以表现为：腰骶部疼痛、不适； 或交替性臀部不适、腹股沟酸痛l2、腰背疼痛、晨僵腰椎各向活动受限、胸廓活动受限l3、也可以表现为：四肢大关节的疼痛l 非对称、反复发作缓解l4、脊柱多自下而上强直，典型表现十年 9Spine CenterBethune hospitalJilin Universityl 10Spine CenterBethune hospitalJilin University竹节状脊柱椎间盘纤维环外层形成韧带纤维赘、椎间盘钙化将相邻椎体连接而成 11Spine CenterBethune hospitalJilin Universityl韧带纤维赘：l反应纤维化本身及其邻近韧带的钙化 12Spine CenterBethune hospitalJilin Universityl体征：l骶髂关节：4字试验l腰椎活动度检查：Schober试验l胸廓活动度检查l实验室检查：l90%患者HLA-B27阳性lRF阴性l活动期：血沉增快、CRP增高、IgA增高 13Spine CenterBethune hospitalJilin Universityl诊断标准（纽约 1984）l临床诊断：la腰痛、晨僵>3个月，活动改善，休息无改善。
lb腰椎额状面、矢状面活动受限lC胸廓活动度低于相应年龄、性别正常人l放射线标准：l双侧骶髂关节炎>=2级 或l单侧骶髂关节炎3-4级 14Spine CenterBethune hospitalJilin University 15Spine CenterBethune hospitalJilin University 16Spine CenterBethune hospitalJilin University 17Spine CenterBethune hospitalJilin University 18Spine CenterBethune hospitalJilin Universityl 谢谢 。