强直性脊柱炎累及双髋关节.pptxVIP

Case DisscusionBy Group Group 2013-07-112011-06-02History Male, 28 years oldHip painNo laboratory examination Final Diagnosisbilateral sacroiliitis seronegative spondyloarthropathy involve bilatreal hip jointsynovial cyst at the front margin of articular ASmainly young adults, mostly male age:10 to 40 years old, average 25hip involved——one-third of patients with ASHLA-B27 positive 90% axial skeletal : bilaterallyperipheral arthritis :asymmetrically ASconventional radiographstwo typical featuresconcentric osteoproliferation with osteophytes around the femoral neckerosions of the acetabulum ASconventional radiographsotherssclerosissynovitis ; enthesitisosteophytosis joint space narrowing—— concentric ,uniform joint effusionsubchondral bone marrow edema periarticular fat depositions DDXRheumatoid arthritis (RA)Tuberculosis (TB) RAautoimmune disorder of unknown etiologycharacteristicsymmetricerosive synovitissometimes multisystem involvementhip involved——5to15%mainly women RAclinical symptompainswellingstiffness motion impairmentlaboratory testsrheumatoid factor(+)elevated ESR and CRP RAimaging appearancesynovitisthickening of soft tissue osteoporosissubchondral cyst formationhomogeneous narrowing of articular spaceerosion of cartilageacetabulum and head of femur both involved RAimaging appearanceMRIearly stage (rich vessels of pannus)T1WI——low signalT2WI——high signallate stage (increased fabre composition)T1WI——isosignalT2WI——isosignal RAsynovial cyst——rare TBpathogenesis —hematogenous dissemination15% cases of osteoarticular tuberculosiscommon age——the second and third decadesthe most common site——vertebral tuberculosis TBlesions on the acetabular side progress less rapidly than lesions on the femoral side TBclinical symptomcommon symptomjoint symptompainfixed deformities of the hippainful limitation of movementmuscle wastingregional lymph node enlargementform of cold abscess with or without sinusespathologic dislocation of the hip TBimaging appearancethickenin