第163课骨关节影像（Bone and Joint Imaging）（011）之-强直性脊柱炎

1、骶髂关节改变：骶髂关节改变从骶髂关节的下2/3处开始，早期关节边缘模糊，主要发生在关节的髂骨侧，骶骨侧改变较轻，因关节面的侵蚀破坏致关节间隙增宽，继而关节面呈锯齿状或串珠状破坏，周围骨质硬化。病变进一步发展，整个关节间隙逐渐变窄、消失，骶髂关节发生骨性强直，有粗糙的条束骨小梁交错通过关节，而软骨下骨硬化带缓慢消失，病变趋于停止。骶髂关节病变多呈双层对称性。

1、sacroiliac joint change: sacroiliac joint change start from the two-thirds of the sacroiliac joint, early joint edge blur, mainly in the joints of iliac side, lateral sacral change less, because of the articular surface erosion caused by the joint gap widened, which in turn are angled joints dentate or beaded destruction, the surrounding bone sclerosis. Lesions in the further development of the whole joint gap gradually narrowed, disappear, sacroiliac joint osseous rigidity, a rough a bunch of trabecular bone staggered through the joints, and sclerosis of subchondral bone was slowly disappear, lesions tend to be stopped. The sacroiliac joint lesions are double symmetry.

2、脊柱改变：往往于椎体前部角隅处发生骨炎、骨质破坏和硬化，致椎体‘交方’。关节突间小关节有糜烂和软骨下骨化。椎间盘纤维化外层钙化，可波及前纵韧带深层，并延伸至椎体边缘，形成韧带赘，呈与椎体终板垂直的细条状影。至病变晚期可出现广泛的椎旁软组织钙化和椎体间骨桥，脊柱呈竹节状强直。在前后位片上，两侧椎间小关节之关节囊和关节周围韧带钙化，呈两条平行的纵行致密‘轨道状’影，而棘上韧带钙化则为循棘突间的单条正中致密带。脊柱强直后椎体显示骨质疏松。脊柱常呈后凸畸形，后凸最显著处多在胸腰段交界处。强直性脊柱炎可发生环枢椎半脱位，但其发生率较类风湿性关节炎少。

2、Spinal changes: usually osteitis, bone damage and sclerosis occur in the anterior corner of the vertebral body, resulting in the 'crossing' of the vertebral body. The joint has erosive and chondral ossification. The outer calcification of the intervertebral disk fibrosis can extend to the anterior longitudinal ligament and extend to the edge of the vertebral body, forming ligaments, which are the thin strips perpendicular to the endplate of the vertebral body. At the end of the lesion, there are extensive vertebral soft tissue calcification and vertebral intervertebral bridge, and the spinal column is gangliform. On the slice before and after, intervertebral joints on both sides of the joint capsule and joint ligament calcification, around the two parallel longitudinal density 'orbit' shadow, and the ligament calcification on the spine is to follow a single median density with spines. The vertebral body of the vertebral column shows osteoporosis. The spine is often presented with a posterior convex malformation, and the most prominent place is at the junction of the thoracic lumbar segment. The incidence of ankylosing spondylitis can occur in semidislocation of the ring, but its incidence is less than that of rheumatoid arthritis.

3、髋关节改变：髋关节是强直性关节炎最常侵犯的外周关节，发生率高达50%，多为双侧受累。X线表现为髋关节间隙变窄，关节面有骨质破坏，股骨头轴性移位，关节面外缘特别在股骨头与股骨颈交界处有骨赘形成，最终可发生骨性强直。关节局部骨质无普遍脱钙征象。幼年性强直性脊柱炎髋部症状出现最早，其X线改变也早于骶髂关节病变。

3、Hip arthroplasty: the hip joint is the most frequently invaded peripheral joint, with a rate of up to 50%, mostly bilateral. X-ray manifestation of hip joint gap Narrows, articular surface with bone destruction, axial displacement, femoral head joint side especially in the femoral head and femoral neck border with osteophyte formation, eventually bony rigidity can occur. There is no general decalcification of bone in joints. The early onset of the hip symptoms of ankylosing spondylitis, the X - ray changes in the sacroiliac joint.

4、胸骨病变：胸骨柄、体间关节病理基础与骶髂关节改变类似，有边缘糜烂，并可发生关节强直。

4、Sternal lesion: the pathologic basis of the manubrium sternum and the sacroiliac joint is similar to that of the sacroiliac joint, with the edge erosion and joint rigidity.

5、耻骨联合和坐骨结节改变：与骶髂关节处改变类似，在女性病人中，耻骨骨炎较严重，但发生骨性强直罕见。坐骨结节处有骨侵蚀和附丽病改变（附丽病是指肌腱、关节囊、韧带于骨附着处的骨化和骨质侵蚀改变，常见于坐骨结节、髂骨嵴、坐骨耻骨支、股骨大小粗隆、跟骨结节等处）。X线表现为具有骨密度的细条索状影至骨面伸向附近的韧带、肌腱，宛如浓厚的胡须，以病变晚期更为明显，并有局部骨质侵蚀。

5、Pubic symphysis and ischial tuberosity change: similar to the changes in the sacroiliac joint, pubic osteitis is more severe in female patients, but osteoarthritis is rare. Ischial tuberosity in change with bone erosion and the attachment (the attachment disease refers to the tendon, joint capsule and ligament in to the bone ossification and bone erosion change, common in the ischial tuberosity, iliac crest, sciatic pubic branch, and the size of the femoral tuberosity, calcaneal tubercle, etc). The X line is characterized by a thin strip of bone density in the bone to reach the adjacent ligaments and tendons, like a thick beard, which is more pronounced in the later stages of the disease and has localized bone erosion.