sapho疑难病例讨论1ppt课件.ppt

J Child Orthop. 2015 Feb; 9(1): 19–27. Bilateral sternoclavicular joint edema in the SAPHO patient J Child Orthop. 2015 Feb; 9(1): 19–27.J Child Orthop. 2015 Feb; 9(1): 19–27. Scintigraphy findings show intensive uptake of the radiopharmaceutical technetium-99m at the sternoclavicular joints and sternum, which represent a “bulls head” sign. Etiology(病因学） Whether the SAPHO syndrome represents a clinical entity by itself； should be considered a subset within the family of spondyloarthropathies脊柱关节病 or be considered a variant of another rheumatic 风湿性 disease (i.e. psoriatic arthritis银屑性关节 炎) is still unknown。 pathogenesis（发病机理） The pathogenesis of SAPHO is probably multifactorial and it involves a combination of genetic, infectious, and immunological components. Treatment Because to the variety of clinical presentations, the treatment of SAPHO syndrome remains a challenge and outcomes are known to be disappointing, especially with the skin component of the disease。 There have been no randomized controlled trials on the effectiveness of various therapies, but nonsteroidal anti-inflammatory drug(NSAIDs) are generally considered as the first-line treatment option. Treatment 其他治疗： Antimicrobial therapy is useful in patients with positive biopsy cultures, but it has little or no effect in others。 四环素、阿奇霉素、新诺明、克林霉素 秋水仙碱；类固醇激素；甲氨蝶呤； 二磷酸盐类； 疑难病例讨论： 疑难病例讨论做为不论是全院还是核医学科都是核心条款。 定义：同一病症连续在门诊就诊3次、住院患者入院7个工作日仍未明确诊断；经我院治疗未能达到预期疗效并持续加重；出现严重医源性或治疗性并发症（含手术并发症）；病情复杂、涉及多个学科；住院超过30天及其他需要讨论的病例。 记录内容包括： ：患者姓名、性别、年龄、 住院号（或登记号）、讨论日期、主持人 及参加人员姓名与专业技术职务、病情摘 要及讨论目的、参加人员发言、讨论意见 等。确定性或结论性意见经主持人审核签 字后记入病历，必要时报医务处备案。 下次病例讨论： 王蓉：内容待定。 HLA:人类白细胞抗原 全身诸骨显影清晰，放射性核素分布不均匀，双侧锁骨近端、双侧胸锁关节、双侧第一前肋、胸骨柄、胸骨体、右5肋软骨交界处、腰5椎体上缘见异常放射性增高影。 双侧锁骨近端、双侧胸锁关节、胸骨体及双侧第一前肋CT显示骨骼轻度膨大，皮质增厚、硬化，髓腔内密度弥漫性增高。胸骨体放射性增高影CT显示相应胸骨体骨皮质增厚、硬化，于双侧第3、5胸肋关节局部见低密度影。右5肋软骨交界处放射性增高影CT未见明显异常。 chamot:查莫特 mandible:下颌骨。 Scintigraphy findings show intensive uptake of the radiopharmaceutical technetium-99m at the sternocl