SPONDYLODISCITIS AND PSEUDOARTHROSIS IN A PATIENT WITH ENTEROPATHIC SPONDYLOARTHROPATHY
SPONDYLODISCITIS AND PSEUDOARTHROSIS IN A PATIENT WITH ENTEROPATHIC SPONDYLOARTHROPATHY
复制标题
DOI：
10.1136/ard.50.2.117
复制
发表时间：
1991-02-01
影响因子：
27.4
通讯作者：
ROBERTSON, D
中科院分区：
文献类型：
--
作者：
CALIN, A;ROBERTSON, D
讨论在脊椎炎中，急性背痛可能由创伤或椎间盘破坏（脊椎炎）引起。Andersson于1937年首次报道了椎间盘病变，3他描述了两名患者腰椎和胸椎椎间盘骨边缘的破坏和硬化。1940年，埃德斯特伦描述了一位病人在一段时间的繁重体力劳动后发生的这种病变。Cawley等在他们对这种病变的综合分析中提出，椎间盘病变有三种类型。5 I型病变累及椎间盘交界的周边区域; II型病变累及椎间盘交界的中央软骨区域; III型病变累及椎间盘交界的中央和周边区域。在不同的系列中，破坏性病变的放射学患病率从1%到28%不等。5 6 I型和II型病变通常发生在疾病的早期阶段，而III型病变发生在疾病的晚期，在非强直脊柱中不常见。如Schmorl和Jung-hanns所述，局限性外周病变（I型）常见于老年性脊柱后凸。7组织学上，纤维环和相邻椎骨的外纤维被血管纤维组织所取代。骨质疏松症的脊椎艾滋病在崩溃的脊椎。影响软骨终板的II型病变可在强直或非强直脊柱中发现。其原因尚不清楚，但被认为与椎体骨质疏松症有关，导致软骨下区域的局灶性骨丢失，并使椎间盘内容物通过软骨终板突出到椎体内。5 6在这方面，值得注意的是，脊柱炎的椎体骨质疏松症可能发生在疾病的早期。8此外，脊椎炎的骨突疾病可能增加穿过椎间盘连接处的力，导致软骨下骨或软骨终板断裂，随后椎间盘内容物脱出进入椎体。6 III型病变见于晚期脊柱炎患者，可能发生于创伤或重体力劳动后，可能发生通过强直的骨突关节的骨折或强直节段的未移位的完全骨折。非脊柱炎的神经弓孤立性创伤性骨折，几年后可能会出现椎间盘交界处的破坏性病变。有时，III型病变可能发生在没有骨折的情况下，并见于非强直节段，其中损伤是跨节段过度用力的结果。III型病变的组织学表现与假关节一致，伴有出血、纤维组织、少量骨痂和相邻椎骨硬化。只有轻微的炎性细胞浸润，这被认为是继发于椎间盘边缘组织的损伤。大多数椎间盘病变患者有背痛，在III型病变的情况下，很少会导致神经系统并发症。“然而，在放射学检查中意外发现此类病变的患者随访了17年，但仍然没有症状。对于那些有严重背痛的人，用支具或脊柱融合术固定受影响的节段似乎能成功缓解疼痛。4大约20%的炎症性肠病患者患有骶髂关节炎，其中只有五分之一会发展为广泛的轴性疾病。周围性关节炎发生在15-20%的炎症性肠病患者中，并且通常是迁移性的、短暂的、非破坏性的和少关节的。骶髂关节炎和中轴疾病，但不是周围的...
Discussion In spondylitis, acute back pain may result from trauma or from discovertebral destruction (spondylodiscitis). Discovertebral lesions were first reported in 1937 by Andersson, 3 who described the destruction and sclerosis of the disc bone border in the lumbar and thoracic spine of two patients. In 1940 Edstrom described such lesions occurring in a patient after a spell of heavy manual work. 4 In their comprehensive analysis of such lesions Cawley et al have suggested that there are three types of discovertebral lesion. 5 Type I lesion affects the peripheral region of the discovertebral junction; type II involves the central cartilaginous region of the discovertebral junction; type III affects both the central and peripheral areas of the discovertebral junction. The radiological prevalence of destructive lesions varies from 1% to 28% in different series. 5 6 Types I and II lesions often occur in the early phases of the disease, whereas type III lesions occur late in the disease and are uncommon in non-ankylosed spines. The localised peripheral lesion (type I) is often found in senile kyphotic spines, as described by Schmorl and Jung-hanns. 7 Histologically the outer fibres of the anulus fibrosus and the adjacent vertebra are replaced by vascular fibrous tissue. Osteoporosis of the vertebrae aids in the collapse of the vertebrae. Type II lesions, affecting the cartilaginous end plates can be found in ankylosed or non-ankylosed spines. Their cause isunknown but is thought to be related to vertebral osteo-porosis producing focal bone loss in the subchondral area and permitting the disc contents to herniate through the cartilaginous end plate into the vertebral body. 5 6 In this regard, it is interesting to note that vertebral osteoporosis in spondylitis may occur early on in the disease. 8 In addition, apophysial disease in spondylitis may increase forces across the discovertebral junction, leading to breaks in the subchondral bone or cartilaginous end plate and subsequent hernation of the disc contents into the vertebral body. 6 Type III lesions, seen in patients with advanced spondylitis, may follow trauma or heavy manual work, and there may be a fracture through the ankylosed apophysial articulation or an undisplaced, complete fracture of an ankylosed segment. 9Isolated traumatic fractures of the neural arch in non-spondylitis may be followed, some years later, by destructive lesions of the discovertebral junction. 7 Occas-sionally, type III lesions may occur in the absence of a fracture and be seen in non-ankylosed segments, where damage is the con-sequence of excessive forces across the seg-ment.'0 The histology of type III lesions is consistent with a pseudarthrosis with haemor-rhage, fibrous tissue, small amounts of callus, and sclerosis of the adjacent vertebral bone. There is only mild inflammatory cell infiltrate, which is thought to be secondary to damage to the tissue of the discovertebral border.Most patients with discovertebral lesions have back pain which, in the case of type III lesions, may rarely lead to neurological complications." Patients, in whom such lesions were detected accidentally during radiological examination, however, were followed up for 17 years but remained asymptomatic.'2 For those with severe back pain immobilisation of the affected segment with braces or spinal fusion seems to be successful in relieving pain. 4 About 20% of patients with inflammatory bowel disease have sacroiliitis and of these only one fifth will develop widespread axial disease. Peripheral arthritis occurs in 15-20% of patients with inflammatory bowel disease and is often migratory, transient, non-destructive, and oligoarticular. The sacroiliitis and axial disease, but not peripheral …