1、肌肉骨骼系统（二）,程克斌,Anatomy,A B C,关节炎arthritis,Definition定义 Disease that affects bones on both sides of the joint space and Narrows the space in between them,Arthritis or Not,AVN,DJD,A,B,C,PVNS,Classification分类,增生性Hypertrophic Bone production Sclerosis 感染性Infectious Destruction of articular cortex 侵蚀性Eros
2、ive Erosions,增生性关节炎Hypertrophic Arthritis,退行性关节炎Degenerative arthritis Primary Secondary Charcot arthropathy（夏科氏关节）,Primary Degenerative Arthritis 原发性退行性关节炎（掌握）,关节软骨内部退变Intrinsic degeneration of articular cartilage Excessive wear and tear Most commonly hips and knees Less commonly shoulders and elbo
3、ws,Primary Degenerative Arthritis 诊断要点,X-ray Findings 间隙变窄Narrowing of joint space 软骨下硬化Subchondral sclerosis 边缘骨赘形成Marginal osteophyte formation 软骨下囊肿Subchondral cysts,Primary DJD of knees affects medial, weight-bearing surface,Primary DJD of hips affects superior, weight-bearing surface,Primary DJ
4、D of knees,Secondary Degenerative Arthritis 继发性退行性关节炎（了解）,Another process destroys articular cartilage Degenerative changes supervene How to recognize Atypical locations (CPPD and knee) Atypical appearance (Marked DJD of 1 hip) Atypical age (DJD in 20 year-old),Secondary Degenerative Arthritis More
5、Causes,Trauma创伤 Infection感染 Avascular necrosis骨坏死 RA类风湿 Hemophilia血友病 Bottom line: Any arthritis can end as DJD,A,B,C,Classification,Hypertrophic Bone production Sclerosis Infectious Destruction of articular cortex Erosive Erosions,Infectious Arthritis（掌握）,Causes： Usually staph ，TB More common in ad
6、ults Usually from local trauma-surgery or accident Children get osteomyelitis Destruction of articular cartilage & cortex Tends to affect one joint,pyogenic arthritis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。,Septic arthritis of toe,Tuberc
7、ulosis of joint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。,pyogenic arthritis 化脓性关节炎 诊断要点,TB,Normal hip,Acetabular white line,Classification Erosive Arthritis,Hypertrophic Bone production Sclerosis Infectious Destruction of articu
8、lar cortex Erosive Erosions,Erosive Arthritis General,Synovial proliferation (pannus formation血管翳) Inflammation Erosions seen in small joints (hands) better than large (hips) Destroy portion of cortex,Erosive Arthritis Types,Rheumatoid arthritis（掌握） Gout Hemophilia Erosive osteoarthritis Rheumatoid
9、variants Psoriatic arthritis Reiters Ankylosing spondylitis（了解） Inflammatory bowel disease,Rheumatoid Arthritis诊断要点,中年女性 双侧对称发病Bilaterally symmetrical 常累及手部小关节 Earliest change: STS MCP, PIP, ulnar styloid 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,A,B,A,B,Ankylosing Spondylitis 强直性脊柱炎（了解）,HLA-B27 positive SI arthritis Squaring of vertebral bodies（方性椎） Bamboo-spine from continuous syndesmophytes（竹节样改变） Peripheral large joint erosive arthritis,强直性脊柱炎,“自女儿国一别，二十年不见，御弟哥哥,别来无恙”,
