摘要
背景:SAPHO综合征是一种罕见的临床综合征,病变主要累及皮肤和骨关节,临床表现多样。目前,各科医师对于SAPHO综合征的骨关节病变的认识并不全面,在临床工作中常发生误诊和漏诊。目的目的:分析SAPHO综合征患者骶髂关节病变的CT表现,提高临床医师对本病的认识及诊断的准确性。方法方法:本研究纳入2014年11月至2015年12月于北京协和医院就诊的70例SAPHO综合征患者,回顾性分析其临床资料及影像学资料,总结其骶髂关节CT的影像学特征。结果结果:70例患者中,31例(44.3%)出现骶髂关节病变。其中,双侧受累者19例(61.3%),单侧受累者12例(38.7%)。12例(38.7%)以髂骨侧病变为主,13例(41.9%)以骶骨侧病变为主。关节受累的具体部位:单独累及前下方滑膜部7例(22.6%),单独累及后上方韧带部2例(6.5%),两部位同时受累22例(70.9%)。CT的影像学特征主要包括:骨质囊变(9.7%),骨质硬化(35.5%),骨质破坏与硬化共存(54.8%);关节间隙狭窄(9.7%),关节强直(12.9%);病变周围软组织均无明确异常。结论结论:SAPHO综合征患者的骶髂关节病变多为双侧受累,骶骨侧及滑膜部受累比例略高,CT表现以溶骨性病变与成骨性病变共存为特征,较少出现关节强直。上述征象可以在影像上提示SAPHO综合征,结合患者的皮肤病变,将更有利于做出诊断。
Background： SAPHO syndrome is a rare clinical syndrome with diverse manifestations, mainly affecting the skin and joints. However, the lesions related to bone and joints are not well understood by clinicians, leading to misdiagnosis in clinical settings. Objective： To retrospectively evaluate CT features of sacroiliac joint（SIJ） disorders in SAPHO syndrome, thus increasing the awareness of SAPHO syndrome among clinicians and improving its diagnostic accuracy. Meth Methods： Seventy SAPHO patients who presented to the Peking Union Medical College Hospital between November 2014 and December 2015 were enrolled in this study. Clinical and imaging materials were retrospectively evaluated and the CT features of SIJ disorders were summarized. Results： Totally 31 patients（44.3%, 31/70） were involved with SIJ disorder. Among these patients, 19（61.3%） were involved bilaterally and 12（38.7%） unilaterally. The lesion mainly located in the iliac in 12 patients（38.7%） and in the sacrum in 13 patients（41.9%）. Detailed parts of the joint involvement were as follows： anteroinferior synovial membrane in 7 patients（22.6%）, posterosuperior ligament in 2（6.5%） and both in the remaining 22（70.9%）.The CT features of SIJ disorders included： bone cystic change（9.7%）, bony sclerosis（35.5%）, a combination of bony erosion and sclerosis（54.8%）; joint space narrowing（9.7%） and ankylosis（12.9%）. Soft tissue was not obviously affected.Conclusions： SIJs are usually bilaterally involved in SAPHO patients, with a slightly high percentage of the involvement in sacrum and synovial membrane. CT manifestations are characterized by the coexistence of osteolytic and osteogenic lesions, with a low prevalence of ankylosis. These CT features could provide certain information of SAPHO syndrome. Skin lesions and other clinical information should be consulted for a comprehensive evaluation and definite diagnosis.
作者
邵暇荔
徐文睿
李忱
赵雪
张伟宏
SHAO Xiali;XU Wenrui;LIChen;ZHAO Xue;ZHANG Weihong(Department of Radiology, Peking Union Medical College Hospital, PUMC ＆ CAMS, Beijing 100730;Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, PUMC ＆ CAMPS, Beijing 100730;Department of Radiology, Beijing Huairou Hospital, Beijing 101400, China)
出处
《中华骨与关节外科杂志》
2018年第1期53-57,共5页
Chinese Journal of Bone and Joint Surgery
