強直性脊柱炎累及雙髖關(guān)節(jié)第1頁/共57頁HistoryMale,28yearsoldHippainNolaboratoryexamination第2頁/共57頁第3頁/共57頁第4頁/共57頁第5頁/共57頁第6頁/共57頁第7頁/共57頁第8頁/共57頁第9頁/共57頁第10頁/共57頁第11頁/共57頁第12頁/共57頁第13頁/共57頁FinalDiagnosisbilateralsacroiliitisseronegativespondyloarthropathyinvolvebilatrealhipjointsynovialcystatthefrontmarginofarticular第14頁/共57頁ASmainlyyoungadults,mostlymaleage:10to40yearsold,average25hipinvolved——one-thirdofpatientswithASHLA-B27positive>90%axialskeletal:bilaterallyperipheralarthritis:asymmetrically第15頁/共57頁ASconventionalradiographstwotypicalfeaturesconcentricosteoproliferationwithosteophytesaroundthefemoralneckerosionsoftheacetabulum第16頁/共57頁第17頁/共57頁ASconventionalradiographsotherssclerosissynovitis;enthesitisosteophytosisjointspacenarrowing——concentric,uniformjointeffusionsubchondralbonemarrowedemaperiarticularfatdepositions第18頁/共57頁第19頁/共57頁第20頁/共57頁第21頁/共57頁第22頁/共57頁第23頁/共57頁DDXRheumatoidarthritis(RA)Tuberculosis(TB)第24頁/共57頁RAautoimmunedisorderofunknownetiologycharacteristicsymmetricerosivesynovitissometimesmultisysteminvolvementhipinvolved——5to15%mainlywomen第25頁/共57頁RAclinicalsymptompainswellingstiffnessmotionimpairmentlaboratorytestsrheumatoidfactor(+)elevatedESRandCRP第26頁/共57頁RAimagingappearancesynovitisthickeningofsofttissueosteoporosissubchondralcystformationhomogeneousnarrowingofarticularspaceerosionofcartilageacetabulumandheadoffemurbothinvolved第27頁/共57頁RAimagingappearanceMRIearlystage(richvesselsofpannus)T1WI——lowsignalT2WI——highsignallatestage(increasedfabrecomposition)T1WI——isosignalT2WI——isosignal第28頁/共57頁

第29頁/共57頁RAsynovialcyst——rare第30頁/共57頁第31頁/共57頁第32頁/共57頁TBpathogenesis—hematogenousdissemination15%casesofosteoarticulartuberculosiscommonage——thesecondandthirddecadesthemostcommonsite——vertebraltuberculosis第33頁/共57頁TBlesionsontheacetabularsideprogresslessrapidlythanlesionsonthefemoralside第34頁/共57頁TBclinicalsymptomcommonsymptomjointsymptompainfixeddeformitiesofthehippainfullimitationofmovementmusclewastingregionallymphnodeenlargementformofcoldabscesswithorwithoutsinusespathologicdislocationofthehip第35頁/共57頁第36頁/共57頁TBimagingappearancethickeningofthesynoviumsubchondralandmarginalbonyerosioneffusionlossofjointspaceperiarticularabscessjuxta-articularosteoporosis第37頁/共57頁第38頁/共57頁第39頁/共57頁第40頁/共57頁第41頁/共57頁第42頁/共57頁第43頁/共57頁第44頁/共57頁第45頁/共57頁第46頁/共57頁第47頁/共57頁TBhipdislocation——uncommon第48頁/共57頁第49頁/共57頁TBtuberculousbursitis——rarecommonsite——trochantericregion第50頁/共57頁第51頁/共57頁第52頁/共57頁hipjointarthritisclinicalsymptom、agegender、laboratoryexaminationHLA-27(+)ASRF(+)RATuberclebacillus

TBimagingappearanceenthesitis、osteophytosis、combinedSIJandspinechangesASobvioussynovitispolyarticular、boneerosion、uniformnarrowingRAmonoarticularnonuniformnarrowingbonedestructionTBFinaldiagnosiscombination第53頁/共57頁ThankYou!Madebychaichao第54頁/共57頁RA

JointTBPVNSGoutyJointinvolvementPolyarticularSymmetricalmonoarticularmonoarticularKnee，80%Thefirstmetatarsophalangealjointsequestrum_+__