在風濕病學與骨科疾病的臨床診療中,脊柱關節(jié)炎及其相關疾病非常復雜,其 多樣性令人感到極具挑戰(zhàn)。這些疾病的臨床表現(xiàn)復雜多變,極易與其他疾病混淆, 常常導致誤診和延誤治療。因此,初學者急需一本能夠深入系統(tǒng)地探討這些疾病臨 床診治的參考書籍。本書正是以豐富的案例和嚴謹?shù)膶W術態(tài)度向我們展示了如何在 復雜的臨床情景中識別和管理脊柱關節(jié)炎及其相關疾病。 本書的編排結構從實際案例出發(fā),涵蓋了典型的強直性脊柱炎和少見的晚發(fā)型 脊柱關節(jié)炎、SAPHO綜合征、感染性疾病及罕見的腫瘤性骶髂關節(jié)病變等多種臨 床表現(xiàn)相似的案例。這些案例不僅全面展示了脊柱關節(jié)炎及相關疾病的臨床面貌, 還深入剖析了診斷過程中可能面臨的困境和陷阱。通過這些案例的細致分析, 讀者不僅可以了解疾病的影像學特點、致病機制,還能夠掌握在不同情況下如何靈 活應對疾病診斷,從而提高自身診斷水平的方法。 令人印象深刻的是,本書特別強調了在臨床診斷中的思辨過程和多維度的鑒 別診斷。書中收錄的許多案例并非教科書中所描述的典型病例,相反,它們呈 現(xiàn)出了復雜的臨床表現(xiàn),如誤診為脊柱結核的強直性脊柱炎、疑似類風濕關節(jié)炎的 外周型脊柱關節(jié)炎等。這些案例生動地提醒我們,臨床診斷不僅僅依賴于影像學或 實驗室檢查結果,更需要結合豐富的臨床經(jīng)驗和靈活的思辨能力。在面對復雜病例 時,醫(yī)生的思維深度和廣度決定了診斷的準確性。 此外,本書對于罕見案例和疑難病癥的探討也極具價值,如少見的米粒體滑囊 炎、腫瘤相關性低磷骨軟化癥,以及甲狀旁腺功能亢進癥相關低磷骨軟化癥等罕見 疾病,這些內容展示了筆者對臨床疑難案例的深入理解和解決能力,也為廣大臨床 醫(yī)務工作者提供了極為寶貴的參考資料。 總體來說,本書的出版無疑是風濕病學與骨科領域的一項重要貢獻。它不僅填 補了脊柱關節(jié)炎及相關疾病診治中某些知識領域的空白,也為我們提供了寶貴的臨 床經(jīng)驗。這本書的內容豐富、分析透徹,既適合一線臨床醫(yī)生作為日常診治的參考 指南,也為從事相關研究的學者提供了深入思考和探索的機會。 作為本書的主審,我深感榮幸,并誠摯地向風濕病學、骨科及相關學科的醫(yī)務 工作者推薦本書。相信它不僅會拓寬我們的臨床視野,更能為患者帶來福祉。
黃 烽
主任醫(yī)師,教授,博士研究生導師。 現(xiàn)任中國人民解放軍總醫(yī)院第一醫(yī)學中心風濕免疫科名 譽主任,全軍風濕病中心主任,全軍醫(yī)學免疫學會副主 任委員,中國中西醫(yī)結合風濕病委員會副主任委員,《中 華風濕病學雜志》副總編。曾任國際強直性脊柱炎協(xié)會 常務理事、中華醫(yī)學會風濕病學分會副主任委員、中國 醫(yī)師協(xié)會風濕免疫分會副會長等。國家自然科學基金杰 出青年基金和中國科協(xié)求是杰出青年獎獲得者,擁有 2 項國家發(fā)明專利,曾獲中華醫(yī)學科技獎一等獎、軍隊 醫(yī)療成果獎一等獎,享受國務院政府特殊津貼。
張江林
主任醫(yī)師,副教授,碩士研究生導師。 中國人民解放軍總醫(yī)院第一醫(yī)學中心風濕免疫科主任醫(yī) 師,F(xiàn)任北京醫(yī)師協(xié)會風濕免疫專科醫(yī)師分會副會長、 北京醫(yī)學會風濕病學分會副主任委員、中華醫(yī)學會風濕 病學分會委員。
朱 劍
主任醫(yī)師,教授,博士研究生導師。 現(xiàn)任中國人民解放軍總醫(yī)院第一醫(yī)學中心風濕免疫科 主任,北京醫(yī)學會風濕病學分會委員,北京醫(yī)學會內 科學分會常務委員,中國初級衛(wèi)生保健基金會風濕免 疫學專業(yè)委員會脊柱關節(jié)炎工作委員會副主任委員, 中國醫(yī)療保健國際交流促進會風濕免疫病學分會常務 委員。曾獲軍隊醫(yī)療成果獎一等獎。
冀肖健
主治醫(yī)師,醫(yī)學博士。 中國人民解放軍總醫(yī)院第一醫(yī)學中心風濕免疫科主治醫(yī) 師。從事風濕病臨床工作,主持北京市自然科學基金1項, 參與多項國家及軍隊基金項目,以第一 / 共同第一作者 發(fā)表論文 20 篇,參編圖書 2 部,參譯圖書 1 部。
趙玉榮
副主任醫(yī)師。 中國人民解放軍總醫(yī)院第一醫(yī)學中心風濕免疫科副主任 醫(yī)師。從事臨床及教學工作多年,以第一作者在核心 期刊發(fā)表論文 3 篇,統(tǒng)計源論文 1 篇,參與編寫論文 10 余篇。
脊柱關節(jié)炎
案例1 髖痛-背痛-頸部活動受限 ························································ 2
案例2 老年男性-慢性腰痛-脊柱骨贅形成 ············································ 6
案例3 老年男性-慢性腰痛-虹膜炎 ····················································· 9
案例4 胸痛-發(fā)熱-腰背痛-多關節(jié)腫痛 ··············································· 14
案例5 臀區(qū)痛-前胸壁疼痛-左膝腫痛 ················································· 18
案例6 臀區(qū)痛-CRP升高-PPD試驗強陽性 ············································ 22
案例7 腰背痛-多關節(jié)腫痛-持續(xù)右肩腫脹 ··········································· 26
案例8 腰背痛-頸部疼痛-摔傷后加重 ················································ 29
案例9 臀區(qū)痛-腰痛-負重后加重 ······················································· 32
案例10 腰背痛-關節(jié)痛-頸部活動受限 ··············································· 35
案例11 炎性腰背痛-多發(fā)骨橋-咳嗽后機械性腰背痛 ····························· 39
案例12 腰背痛-周身疼痛-腰椎三柱病變 ············································ 44
案例13 臀區(qū)痛-左膝腫痛-低熱 ························································ 48
案例14 交替性雙髖疼痛-腰背痛-發(fā)熱 ··············································· 51
案例15 青年男性-寡關節(jié)炎-抗環(huán)瓜氨酸肽抗體陽性-關節(jié)結構破壞 ·········· 55
案例16 腰背痛-多關節(jié)腫痛-發(fā)熱 ····················································· 59
與脊柱關節(jié)炎有類似表現(xiàn)的其他風濕性疾病
案例17 間斷腰痛-胸鎖關節(jié)腫痛-掌跖膿皰病 ······································ 64
案例18 胸痛-手足膿皰-慢性髖關節(jié)痛 ··············································· 68
案例19 右髖痛-骨肥厚-痤瘡-膿皰病 ················································· 72
案例20 腰痛-左腿疼痛-右鎖骨區(qū)疼痛-雙手皮疹 ·································· 77
案例21 發(fā)熱-多關節(jié)腫痛-骨破壞-白細胞減少 ····································· 81
案例22 踝痛-臀區(qū)痛-腰背痛 ··························································· 87
案例23 發(fā)作性關節(jié)腫痛-腰痛-高尿酸血癥 ········································· 90
案例24 多關節(jié)腫痛-頸部疼痛-鞏膜藍染 ············································ 93
案例25 肘關節(jié)活動受限-膝痛-髖痛 ·················································· 98
案例26 頸后區(qū)疼痛-外周關節(jié)疼痛 ·················································· 102
需與脊柱關節(jié)炎相鑒別的感染性疾病
案例27 臀區(qū)疼痛-腰背痛-發(fā)熱 ······················································ 108
案例28 反復發(fā)熱-關節(jié)腫痛-非甾體抗炎藥效果欠佳 ···························112
案例29 臀區(qū)痛-發(fā)熱-呼吸困難-骶髂關節(jié)炎 ·······································116
案例30 發(fā)熱-頸痛-胸痛-背痛 ························································ 120
案例31 腰背痛-發(fā)熱-骶髂關節(jié)炎 ··················································· 123
案例32 肌痛-指端潰瘍-右膝關節(jié)腫痛 ············································· 126
案例33 雙手遇冷變白-多關節(jié)疼痛-下肢無力 ···································· 130
需與脊柱關節(jié)炎相鑒別的腫瘤性疾病
案例34 發(fā)熱-臀區(qū)痛-全血細胞減少-淋巴結腫大 ································ 136
案例35 腰背痛-關節(jié)痛-嗜酸性粒細胞增高-骶髂關節(jié)炎 ······················· 139
案例36 血細胞減少-腰背痛-發(fā)熱 ··················································· 143
案例37 右髖疼痛-低熱-腰背疼痛 ··················································· 148
案例38 多關節(jié)屈曲-多關節(jié)腫脹-駝背-張口受限 ································ 152
案例39 臀區(qū)痛-骶髂關節(jié)骨質破壞-軟組織腫塊 ································· 157
案例40 腰痛-肌無力-蹣跚步態(tài) ······················································ 162
案例41 右上頜腫物-腰背痛-低磷血癥 ············································· 167
與脊柱關節(jié)炎有類似表現(xiàn)的其他中軸或關節(jié)疼痛
案例42 多關節(jié)腫痛-腰背痛-高鈣血癥 ············································· 172
案例43 多發(fā)骨折-骨質疏松-低血磷-低血鉀-皮下多發(fā)腫物 ·················· 177
案例44 腰部無力-晨僵-鴨步步態(tài) ··················································· 182
案例45 石化耳-旋頸受限-低血糖-高血鈣 ········································· 186
案例46 雙手指疼痛-關節(jié)旁異物 ····················································· 190
案例47 左髖疼痛-腰椎強直-多關節(jié)活動受限 ···································· 194
案例48 皮疹-發(fā)熱-臀區(qū)痛 ···························································· 198
案例49 腰骶痛-臀區(qū)痛-骶髂關節(jié)硬化 ············································· 204
案例50 先天性聽力喪失-腰骶痛-夾心椎改變 ······························ 207
案例51 踝關節(jié)腫痛-腹股溝疼痛-腰痛 ··············································211
案例52 指間關節(jié)膨大-右膝疼痛-步態(tài)異常 ······································· 216
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