易误诊的强直性脊柱炎

发布时间:2019-09-26 21:20

说起强直性脊柱炎,很多人马上联想到那些身体向前极度佝偻、行动极端不便的病人。人们大都知道,病到这个份儿上,就没办法治了。但是人们普遍不知道的是,这种病发展到晚期往往是早期误诊的结果,如果能做到早期发现,治疗是完全可以控制的。
    在本院病房,记者访问了几位因强直性脊柱炎而住院的病人,令人吃惊的是这些小伙子在来此住院之前,全都有多次误诊的经历。“我刚发病时是右腿疼,去了几家医院都说是坐骨神经痛,但怎么也治不好,这么折腾了两个月,以后两条腿轮着疼,关节也肿了,这才知道治错了。”“我刚开始是后腰疼,拍了片子医生说我是腰椎间盘突出,可治着治着脚和腿都疼起来,还发起低烧,换了家医院先说我是痛风、后说我是类风湿,直到进了这家医院才确诊得的是强直性脊柱炎。”
  为什么这些病人都曾误诊呢?科主任医师介绍,类风湿关节炎与强直性脊柱炎都是自身免疫性疾病,医学界曾长期将二者混为一谈,认为强直性脊柱炎是类风湿性关节炎的中轴型,近年来才认识到二者在病理上并不相同。类风湿性关节炎是包裹关节的滑膜出现问题;强直性脊柱炎是肌腱附着点发炎,而且这种炎症多发生在骶髂关节处。从片子上来看,先是锥体之间炎症、边缘密度增高、粗糙,再骶髂关节融合钙化,最后形成骨桥,并逐渐向腰椎、胸椎、颈椎发展,严重的,病人变成硬板腰或驼背,影响功能,丧失劳动能力。此病常常侵犯年轻男性。“医生误诊是由于此病初发时还未出现关节病变,症状不典型,只是腰骶部疼、后背疼,还有的表现为屁股疼、腹股沟疼、肋间疼、足跟疼等,一般有肌腱处都可出现疼痛,有的病人还会有低烧、关节肿症状,这时医生不能仅局限在类风湿、腰椎间盘突出、痛风、坐骨神经痛上,而应高度怀疑强直性脊柱炎,及时给予相关检查。”强直性脊柱炎病人多数有家族史,确诊可查HLA-B27基因,90%的病人此基因为阳性,如再有骶髂关节CT片配合,则可确定无疑。基层医生常常以X线片诊断为依据,但此病早期骨骼的变化X线片是看不出来的,容易延误治疗时机。
  目前现代医学治疗此病尚无理想方案。一般常用的药物包括激素类、非甾类、免疫抑制剂等,但只能缓解症状,不能控制病情发展,更不能改善强直的状态。尤其是目前常用的一些药物对生殖系统有不
良影响,不适用于未婚男青年。
  本研究中心医务人员深入研究强直性脊柱炎多年,逐渐积累经验,形成了独到的认识。他们认为,该病侵犯脊柱,“不通则痛”,属于中医“痹症”范畴,其部位处于中医的督脉循行处,是本虚标实之候,以肾督不足为本,外邪侵袭与瘀血内阻为标。急性期以关节红肿热痛为主,治宜清热利湿,活血通络。后期腰背酸痛,活动受限,与肾虚督弱相关,应以补肾通督,养血柔筋,通络止痛为治则。为此,该院研制了“强直骨宝康”系列药物不仅改善病人症状,控制或延缓病情发展,而且不良反应少,耐受性好。
  30岁的宋艳华去年家里装修后出现腰背疼、腿疼,2天后开始发高烧、眼睛发红。一家骨科医院根据他的X线片诊断为腰椎关节增生,用了几天激素后好转。但没过几天又高烧39度,用上激素仍1个月不退,又换了一家医院,先后按鼻窦炎、结核治疗无效,最后查了HLA-B27才确诊为强直性脊柱炎,但没有有效治疗方法。今年4月,仍高烧39度的宋艳华被用车推着本院,经治疗1周后退烧,1个月后可走路,2个月后出院,现已上班。
  其主治医生最后强调:“强直性脊柱炎分4级,宋艳华是2级,骶髂关节还未完全长死,如到了完全长死的4级,谁也没有回天之力。我想提醒大家的是,对这种病要有高度警觉,因为很多病人因腰疼首先到骨科就诊,而且他们90%会继发椎间盘退变或膨出,医生往往以为找到了病根,就不再检查骶髂关节,以至使治疗走弯路,轻病拖重,甚至丧失了治疗时机。” (中华强直性脊柱炎研究中心 )


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