成人强直性髋关节炎分期

Staging of hip pathological changes in adult ankylosing spondilitis

目的:探讨强直性髋关节炎如何从平片上判断预后功能分期。方法:100例成人AS髋关节炎,男91例,女9例;根据法定成人年龄,本组最小19岁,只有1例71岁,平均29.9岁。临床主要表现为全身乏力,腰背和髋部疼痛,功能障碍。结果:100例成人强直性脊柱炎,其中7例行MR成像检查。均有骶髂关节和髋关节病理性征象和股骨头灶性坏死。关节间隙不同程度狭窄达95%、股骨头关节边缘滑膜骨化发生率达84%。垂线征是一种骨化线,它从股骨头内下缘向外下至股骨颈,发生率为69%。100例成人强直性脊柱炎髋臼窝狭窄的发生率高达75%。耻骨联合边缘硬化或吸收和坐骨结节大收肌腱附着点骨化发生率为53%。根据上述综合征象,提出髋关节炎分为4期。Ⅰ期:两侧髋关节变化轻微;Ⅱ期:髋关节狭窄伴随关节周围有明确异常征象;Ⅲ期:髋关节严重狭窄伴随关节周围的严重异常;Ⅳ期:髋关节韧带骨化融合或骨性融合。结论:以髋关节软骨坏死的程度可将强直性髋关节炎分为4期,体现了预后功能的判断。

Objective To predict the prognosis of hip function in ankylosing spondylitis（AS） from radiograph of the hip arthitis. Methods： In 100 cases of ankylosing spondylitis, MRI was performed in seven cases of them, 91 were male and 9 female. The age ranged from 19 to 71 years with an average of 29.9 years. Chief clinical manifestations were genera[ weakness and pain in low back and hip with disturbed function. Results： Pathologic signs were shown in the sacroiliac and hip joints and focal osteonecrosis in the femoral head. Significant narrowing of joint space was found in 95%. Marginal synovial ossification of femoral head wits found in 84%. Sagging rope sign,an ossification line ranning from medioinferior border of femoral head lateroinferior ly lolateral border of femoral neck.was found in 69%. Narrowing of acetabulnm was found in 75%. Margional sclerosis or absorption of symphysis pubis and ossification in ischial tuberosity at the attachment of adductor major were found in 53%. According to the related signs a grading of 4 grades was suggested its follows, Grade Ⅰ： minimal changes in bilateral hip joints. Grade Ⅱ ： narrowed hip joinl with significant periarticular abnormal signs. Grade Ⅲ ： severe narrowing of hip joint space with severe periarticular abnormalities. Grade Ⅳ ： ossification and coagulation or ossifie coagulation of articular ligment. Conclusion： The grading according to the severity of chondronecrosis into 4 grades was thought practicable for predicting the functional prognosis.