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血清阴性脊柱关节病与致密性髂骨炎的鉴别 |
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曾庆馀 许杰洲 刘源
【摘 要】 目的 提高血清阴性脊柱关节病(SPA)与致密性髂骨炎(OCI)的鉴别诊断水平。方法 对X线平片诊断的6例OCI病史、平片、CT片再行分析并行HLA-B27等检查。结果 6例X线平片诊断的OCI中，骶髂关节炎Ⅲ级3例，Ⅱ级3例，均符合欧洲血清阴性脊柱关节病研究组(ESSG)SPA分类标准。结论 对X线平片诊断的OCI应慎重，疑似SPA病例应进一步检查，并按ESSG标准除外之。
【关键词】 血清阴性脊柱关节病 致密性髂骨炎
Differential diagnosis between seronegative spondyloarthropathy and osteitis condensans ilii
ZENG Qingyu XU Jiezhou LIU Yuan
(First Affiliated Hospital of Shantou University Medical College,Shantou 515031)
【Abstract】 Objective To improve the recognization of the differential diagnosis between seronegative spondyloarthropathy (SPA) and osteitis condensans ilii (OCI).Methods Case history,pelvic radiographies,sacroiliac joint CT of 6 cases those had been diagnosed as OCI by pelvic plain X-ray films were re-studied;HLA-B27 were tested in some patients.Classification criteria of SPA of the European Spondyloarthropathy Study Group (ESSG) were used.Results All of the 6 cases were fulfilled the ESSG classification criteria of SPA.Of which,the CT features of sacroiliae joint revealed Ⅲ degree of sacroiliitis in 3 cases,and the other 3 cases revealed Ⅱ degree of sacroiliitis.Conclusion Attention should be paid to the case which is diagnosed as OCI.Sacroiliac joint CT scan,and ESSG criteria are useful in the differential diagnosis.
【Key words】 Seronegative spondyloarthropathy Osteitis condensans ilii
致密性髂骨炎(osteitis condensans ilii，OCI)一般认为是几乎只见于妊娠或产后妇女的无症状性或自限性疾病〔1〕。但有时与血清阴性脊柱关节病(seronegative spondyloarthropathy，SPA)之骶髂关节炎在X线平片上很难鉴别。现将本院3年来X线平片诊断为OCI，而经CT检查确诊为SPA的6例报告如下。
1 资料和方法
1.1 一般资料：6例均为汕头大学医学院第一附属医院风湿病专科1995年—1997年门诊病人，因腰、腿或四肢关节不适来诊，X线骨盆平片报告为“致密性髂骨炎”者。
1.2 方法：记录病人一般临床资料和病人对非甾类抗炎药(NSAIDs)反应并作骶髂关节CT检查。X线平片和CT片再混入等量正常人，≥2级骶髂关节炎的X线和CT平片，由放射学和风湿病学医师双盲复阅。
1.3 骶髂关节CT检查：美国PQ 2000型全身CT机，窗位/窗宽550/1500(Hu)，层距4 mm。
1.4 放射学OCI诊断标准：单侧或双侧骶髂关节附近髂骨下部出现三角形硬化区者〔2〕。
1.5 血清阴性脊柱关节病的诊断：用欧洲脊柱关节病研究组(Eu[1] [2] 下一页
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