DESTRUCTIVE LESIONS OF VERTEBRAL BODIES IN ANKYLOSING-SPONDYLITIS
DESTRUCTIVE LESIONS OF VERTEBRAL BODIES IN ANKYLOSING-SPONDYLITIS
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DOI：
10.1136/ard.31.5.345
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发表时间：
1972-01-01
影响因子：
27.4
通讯作者：
KELLGREN, JH
中科院分区：
文献类型：
--
作者：
CAWLEY, MID;CHALMERS, TM;KELLGREN, JH
Andersson（1937）首次报道了这类病变，他在两名患者的x线片上描述了腰椎骨和胸椎椎间盘边缘周围的硬化和破坏。最早的重要临床观察是由Edstr6m（1940）进行的。在一篇关于阿斯伯格综合症性质的论文中，他提到了一位男性病人，他在发病几年后，在一段时间异常繁重的工作中，背部出现了严重的疼痛；一年后x线片显示T12/L1椎间盘周围的椎体破坏。怀疑为肺结核，但未作病理检查。回想起来，这一临床序列在某些方面堪称典范，但在随后的报道中却很少得到重视。事实上，具有破坏性病变的患者的纯粹临床方面并没有在文献中得到很好的记录，也没有成为正式研究的主题。1951年，Guest和Jacobson（1951）以及forestier、Jacqueline和Rotes-Querol（1951：译）再次简要地提到了这些病变。1956)，后者的作者在他们对200例AS患者的回顾中遇到了两个病例。第二年，Romanus和Yden（1952）描述了椎边缘前外侧表面的浅表、短期侵蚀，他们称之为“前脊柱炎”。他们系统的放射学研究是由于他们遇到了患有AS和椎体严重破坏性病变的患者；在AS早期发现靠近椎间盘的轻微椎体侵蚀（前脊柱炎），他们推测严重的破坏性病变可能是该疾病原发性炎症期的异常延伸。由于最近的病理研究（Ball, 1971）表明，如上所述的前脊柱炎可能是椎环特征性骨化的前兆（图1），因此这一点似乎很重要
The first report of such lesions is attributable to Andersson (1937), who described sclerosis and destruction around the disc margins in lumbar and thoracic vertebrae in radiographs of two patients. The earliest significant clinical observations were made by Edstr6m (1940). In a paper on the nature of AS, he referred to a male patient who, some years after the onset of the disease, developed severe pains in the back during a spell of unusually heavy work; a year later radiographs showed vertebral destruction around the T12/L1 disc. Tuberculosis was suspected but the lesion was not investigated pathologically. In retrospect this clinical sequence is in some respects exemplary, yetit receives little emphasis in subsequent reports. Indeed, the purely clinical aspects ofpatients with destructive lesions are not well documented in the literature and have not been made the subject of a formal study. In 1951 the lesions were again briefly mentioned by Guest and Jacobson (1951) and Fores-tier, Jacqueline, and Rotes-Querol (1951: trans. 1956), the latter authors having encountered two cases intheir review of 200 patients with AS. The following year Romanus and Yden (1952) described thesuperficial, short-lived, erosion of the anteriorand antero-lateral surface of the vertebral rim which they called'anterior spondylitis'. Their systematic radio-logical studies were prompted by their having encountered patients with AS and severe destructive lesions of vertebral bodies; having discovered minor vertebral erosions close to discs (anterior spondylitis) in the early stages of AS, they speculated that severe destructive lesions might be exceptional extensions of the primary inflammatory phase of the disease. Since recent pathological studies (Ball, 1971) indicate that anterior spondylitis, as defined above, is probably the precursor of the characteristic ossification of the annulus (Fig. 1), it seems important