风湿性疾病与股骨头坏死

发布时间:2019-09-26 21:15

  风湿性疾病是一组病因复杂,病理表现多样的骨关节及其周围软组织的疾病,一般多发于气候寒冷潮湿地区,在我国普遍存在,华南较少,往北渐多。风湿性疾病常常会引起不同程度的骨质改变,是股骨头坏死的诱因之一。风湿性疾病常常会引起不同程度的骨质改变,是股骨头坏死的诱因之一。临床上风湿性疾病合并股骨头坏死常见于两大类:强直性脊柱炎(简称AS)合并股骨头坏死,类风湿性关节炎(简称RA)合并股骨头坏死。 

  股骨头坏死 

 股骨头缺血性坏死是骨科的一大顽症,俗称不死的癌症。发病有上升趋势,不分老幼。早期难确诊,患者有侧臀部痛疼,腹股沟痛,股膝关节局部痛疼,活动时极易疲劳。所以早期往往会误诊为劳累过度所致。随着病情的发展,患者下肢痛疼跛形,活动受限,继而发生股肌萎缩,给病人造成极大痛苦。在X光下,会看到表面粗糙,缺损塌陷,皲裂等不规则现象。发病原因主要有以下因素,长期饮酒或用激素药物引起,也有创伤或手术引起,劳累过度或风湿邪毒侵入也会引起,其它如髋关节发育不良,骨关节病,妊娠等也会引起此病。这些因素影响了肝脾肾的正常功能,使肝脏亏损,外邪乘虚而入,造成气血不足而瘀滞,局部血液循环受阻,股骨头缺乏营养导致坏死。不少患者采取西医治疗,如手术、打针、减压、药物注射、血管植入等法治疗,都无显著疗效,给病人造成极大痛苦和不必要的经济负担。特别是置换人工髋关节,手术更是昂贵。这些疗法是大多数可以非手术治愈的患者,却因手术不佳而造成医源性终生残疾。

 
        什么是股骨头坏死 

 股骨头坏死又称幼年性畸形性骨软骨炎,股骨头上端骨骺坏死,扁平髋等。约99%为单侧发病,而双侧病变极少,且不会同时发病。易发于312岁儿童,男孩多于女孩。其主要病理改变,是因股骨头血液循环障碍,而出现的运行性改变,跛行、疼痛。凡是因外伤或其他病变所引起的骨骼的血液循环障碍,不能迅速代偿或修复者,均可造成骨坏死。骨坏死目前临床上把股骨头缺血性坏死列为主要的治疗对象,而忽略了其他部位,使其他关节失去了最佳的治疗时期,导致关节畸形‘功能受限等症状。据统计:患股骨头坏死的占100%,患膝关节坏死95%,肩关节坏死80%,踝关节坏死占45%。其他小关节有:手腕的月骨,脚上的距骨等部位均有发病。 


       股骨头坏死的发病情况如何 

 1888年世界医学界首次认识股骨头坏死这一疾病至今,股骨头坏死已由少见病转变为多发病、常见病。尤其是激素的问世及其广泛应用以来,股骨头坏死的发病率逐渐上升。加之交通事故的增多,人们生活方式的改变,均使该病患者数量增加。据不完全统计,目前全世界患此病者约3000万人,我国约有400万人。最新的调查表明,该病的发生无明显性别差异,任何年龄均可患病,而有过激素应用史、髋部外伤史、酗酒史、相关疾病史者发病的机率明显增多。 


  股骨头坏死的病因是什么 

 (一)创伤性
   ①由于髋部外伤后,股骨颈骨折,髋关节脱位。

  ②儿童多因蹲伤、扭伤或半脱位所致的。或既没有骨折,又没有脱位的血管支损伤,均可造成股骨头缺血坏死。
  (二)非创伤性
  (1)长期或大量应用糖皮质激素占43%
  (2)酒精中毒
  (3)减压病
   潜水、飞行人员在高压情况下,血液和组织中溶解的氮增加,环境压力降低时,已溶解的超量氮需逐渐经由肺部排出,若压力降低过快,氮气来不及排出,即在体内游离出来,形成气泡,产生气体栓塞,气体栓塞在血管,血流受阻,股骨头局部血供变差,缺血坏死。
  (4)其他
   高血压、糖尿病、动脉硬化、肥胖症、痛风、放射治疗、烧伤后,也可造成股骨头坏死。 


  股骨头坏死的高危人群有哪些 

 1)长期应用激素类药物
  由于患者病情不稳定,需要长期大量服用激素类,如:强地松、地塞米松及皮质激素等药物。一般可导致双侧股骨头坏死。
  (2)长期大量饮酒者
  随着社会的发展,人们的交往日益频繁,长期大量的饮酒有时也在所难免,而嗜酒者则对酒情有独钟,喝起酒来没有节制。
  (3)有过髋部外伤史者
   交通事业的飞速发展,交通工具有日新月异,交通事故的发生率也在逐年增加,生活、工作、运动中不慎而造成的股骨颈骨折、髋关节脱位或无骨折脱位的髋部外伤均可造成股骨头供应的血管受到损伤,为股骨头坏死埋下了隐患。其股骨颈骨折并发股骨头坏死者最为多见。
  (4)其他
   潜水、飞行人员、肥胖症、高血压、糖尿病、动脉硬化、痛风、需接受放疗者、烧伤后、血红蛋白病等,也是容易发生股骨头坏死的高危人群。


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