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1、1Spine CenterBethune hospitalJilin University 强直性脊柱炎简介刘理迪 2010-5-142Spine 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
2、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 University6Spine CenterBethune hospitalJilin University7Spine 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 hospital
3、Jilin 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 Univers
4、ityl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
