强直性脊柱炎的危害、预防、治疗

发布时间:2019-09-26 21:20

 腰、颈、髋部疼痛,全身乏力,骶髂关节酸困,不适,发硬。腰前弯,后仰,左右侧弯均受限。久站、久坐后僵痛加强。行走用力时及腰部转动或姿势不当时,均可使腰僵痛加重。剧烈疼痛发生在夜间,牵射致颈部、肋间、上肢、骶部、下肢,时常痛醒。只能起床活动后才能再次入睡。严重者见背、腰、颈、髋关节呈半固定状态伴僵痛。最后导致头部固定于前屈位,脊柱为"罗锅",腰部为"乞求者"姿势,骶髂部为"鸭式"步态,转身时需整个身体转动的"连轴转",膝不能弯曲,髋不能抬起等严重畸形,很多方法治疗效果均不显著,部分治疗显效者又易反复,直至瘫痪。丧失生活能力,故强直性脊柱炎被俗称“"不死的癌症”。
    强脊炎虽然难以确诊,但是临床经验丰富的专科医师还是能够尽早确诊地!遗憾的是大部份早期确诊患者,因临床症状不是特别严重,仅是疼痛,多数患者盲目使用止痛药治疗,稍待疼痛好转,就停止治疗;而后反复发作,多次使用止痛药,直至背、腰僵直,髋关节活动受限时才引起重视。但是这时已到强脊炎晚期,部分部位已残废,给治疗带来很大的难度。
专家建议:15-30岁的青少年,背、腰疼痛伴早晨僵硬半年以上者,应及时到医院拍骶髂关节正位X光片,若骶髂关节有改变者,即可确诊为中、早期强脊炎。确诊后应尽早接受正规治疗,按规定巩固一定的疗程,绝大多数是可以完全治愈的!
大腿内、外侧痛,牵涉膝部或腰部疼痛半年,伴跛行,活动后加重,休息后减轻,CT片示:股骨头有囊性变者,即可确诊为早期股骨头坏死。早期股骨头坏死一般治疗五个疗程(一月一疗程),即可完全治愈。

强直性脊柱炎病人在什么情况下采取外科治疗?

尽管随着现代医学的发展,在强直性脊柱炎的治疗上已经积累了很丰富的经验,但至今为止世界上尚未发现某一种特效药可以终止疾病的进一步发展;同时由于仍有很多医生对本病的认识不清,常常造成误诊、漏诊,使病人得不到及时治疗,最终导致脊柱强直,面对已经强直的关节是不能用任何疗法使其恢复的,因此对某些强直性脊柱炎病人需要手术治疗。但手术治疗也只是对症治疗,其目的是改善病人的功能,使他们能生活自理,提高生活质量。强直性脊柱炎的手术指征包括几个方面:对有严重脊柱畸形的病人可作脊柱矫形手术(如胸椎、颈椎截骨术);对髋关节、膝关节活动明显受限者,可采取关节置换或成形术,少数心瓣膜关闭不全严重者还需考虑换瓣术。

强直性脊柱炎的病因是什么?

强直性脊柱炎的病因尚未完全明确,目前认为与下列因素有一定关系:
   (1)基因因素:本病发病与遗传因素有密切关系,强直性脊柱炎的HLAB27 阳性率高达90%96%,家族遗传阳性率达23.7%。类风湿者其家族的发病率为正常人的21 0倍,而强直性脊柱炎家族的发病率为正常人的30倍。
   (2)感染因素:泌尿生殖系感染是引起本病的重要因素之一,盆腔感染经淋巴途径播散到骶髂关节再到脊柱,还可扩散到大循环而产生全身症状及周围关节、肌腱和眼色素膜的病变。    

(3)内分泌失调或代谢障碍:由于类风湿多见于女性,而强直性脊柱炎多见于男性,故被认为内分泌失调与本病有关。但利用激素治疗类风湿并未取得明显效果,激素失调与本症的关系也没有肯定。肾上腺皮质机能亢进的病人患类风湿或强直性脊柱炎的比率无明显增加或减少。
   (4)其他因素:年龄、体质、营养不良、气候、水土、潮湿和寒冷。其它包括外伤、甲状旁腺疾病、上呼吸道感染、局部化脓感染等,可能与本病有一定关系,但证据不足。

 

如何预防患上强直性脊柱炎

 强直性脊柱炎的病因与遗传、感染、免疫、环境等因素有关。本病好发于男性,且20~30岁之间的男性是高发期,而在这一人群中与自己有血缘关系的近亲,如有驼背、板状背等变化的,而本人又是HLA-B27阳性者,则应特别警惕患上强直性脊柱炎,当然单纯的HLA-B27阳性不会必然患上强直性脊柱炎,但这类人群中应积极预防肠道、泌尿系感染等,注意饮食卫生。注意泌尿生殖系统卫生,如出现上述疾病,则应积极抗感染治疗,防止诱发强直性脊柱炎的发生。
         环境因素也是不可低估的诱因,因此这类人群在起居中一定要慎防风湿寒之邪,各季注意保暖,并且增强机体免疫功能。正气内存,邪不可干,邪之所凑,其气必虚,气是指人的体质或抗病能力。机体正气盛则能抵御风寒湿之邪的侵袭。如素体虚弱不足,或因情志、饮食、劳倦内伤而致气血虚弱,则易患病。正如在同样的致病条件下,有的人患病,有的人健康,便是这个道理。因此风寒湿邪,及一些感染源虽然是致病因素,但如果一个人机体抵抗力增强,则不一定患病。
         反之则风寒湿邪便可入侵经络、筋脉,导致气血不通而发病。故您平素应注意积极锻炼身体,有一个健康的体魄,良好的心态,正确对待生活。不要因自己是强直性脊柱炎患病的危险人群,就忧心忡忡,消极生活。因为您并不必然患强直性脊柱炎,它也不是像血友病那样毫无疑义的显性遗传。
强直性脊柱炎的治疗
          
强直性脊柱炎的治疗目标为:

1.减轻疼痛,

2.保持脊椎活动范围及功能,

3.并预防并发症的发生。
        .患者教育与遗传谘询 强直性脊柱炎的病程通常是慢性、反反覆覆的,因此,让患者了解疾病的病程、预後及可能的并发症,并能充份地配合追踪及治疗是最基本的。医师应适当地给予患者遗传谘询及生活型态的宣传教育。睡眠干扰常是主要的问题,教导患者睡姿宜平躺或趴睡,枕头宜低,床板宜硬,铺约 五公分 厚之软垫。 在遗传谘询方面,據统计,所有HLA-B27(+)的人,有2-10%终将发展成AS;若爸爸为AS患者,则小孩得AS之可能性约为10%
         .运动及物理治疗 运动对强直性脊柱炎患者是非常重要的。对减轻疼痛,保持脊椎活动范围及增进生活质量皆有帮助。运动种类不限,原则上只要能活动关节的运动皆可----如柔软体操、游泳、跳舞...等都是很好的运动。少数不动脊椎的运动(如自行车)及剧烈碰撞的运动(如拳击)则应避免。 维持正确的姿势也很重要,应避免长时间维持一个姿势不动(""在沙发上看电视...);鼓励患者多做伸展运动及伸张脊椎的运动,以预防脊椎的变形。
         .药物治疗 1. 消炎止痛药(NSAID) 目的在减轻疼痛,使患者能多做运动,并增进生活质量;不能改变疾病的病程及活性。剂量可由患者根據疼痛程度自行调整给药,以晨间僵硬为主的症状,可於睡前投与长效剂量。可能的副作用为:肠胃不适、水肿、肾功能障碍等。 2. 免疫调节剂 最常被使用的药是「磺胺匹林」Salfasalazine,具有调节满免疫系统的功用,可改变强直性脊柱炎的疾病活性。一般建议应早期使用,少数人使用後有副作用--主要是皮肤过敏、肠胃不适、肝功能障碍...等。 3. 特效治疗特效治疗“生物植入术”是针对强直性脊柱炎专方,既有明显的消炎止痛作用,又有显著的免疫调节作用。能快速减轻或消除炎症性疼痛,改善以晨间僵硬为主的症状。适应症包括: 1).40岁以前发病者, 2).疾病活性仍高时,3).有周边关节炎及关节外症状、晨间僵硬者,4).发病初期1-10年内。 患者接受治疗,3个月1疗程,根据患者病情的不同,25个疗程可达临床治愈。 “生物植入术”能有效调节机体的免疫系统,改变强直性脊柱炎的疾病活性,阻止炎症发展;改善钙磷代谢,防治骨质疏松,阻止椎体变形;抑制成纤维细胞增殖,防治韧带硬化、僵直,阻止脊柱强直;改善胃肠及肝肾功能,提高机体的抗病能力。 病程及预後 强直性脊柱炎的病程通常是慢性、反反覆覆的。评估疾病活性最好的指标是患者的症状。整体而言,只要积极的采用有效治疗并多运动,强直性脊柱炎的预後是相当良好的,一般并不影响寿命(14)。百分之九十的患者仍然可以拥有良好的生活质量。预後不好的指标是:1.发病年龄小於十六岁,2.有周边关节炎者,3.侵犯关节以外器官的患者,4.疾病活性常居高不下者。 结语 强直性脊柱炎是一个常见但却容易被忽略的疾问题。经过详细的询问病史、理学检查、X光摄影及医师的警觉心,要诊断强直性脊柱炎其实并不难。尤其年轻人的反覆下腰痛,若并有晨间僵硬,应考虑强直性脊柱炎之可能。早期诊断及治疗有助於改善病程并增进生活质量。治疗原则为积极采用有效的治疗方法(如:生物植入术、关节松解术)。一旦被诊断强直性脊柱炎,最重要的是严格按规定疗程服药治疗并定期复诊检查,以避免脊椎变形及并发症。

治疗特色

非手术治疗系列
    椎间盘突出症的治疗方法,取决于此病的不同病理阶段和临床表现,以及病人的身体和心理状况。在医学发展的今天,椎间盘突出症的治疗方法不外乎两种:即非手术治疗和手术治疗。我中心在众多的专 家 教授们多年的临床努力下,在非手术治疗领域走在全国乃至世界的前例。自1999"椎管扩张术""神经根松解术"两种新方法运用于临床之后,大大的提高了保守治疗的治愈率,经过多年实践证明,保守治疗绝大多数腰椎间盘突出症患者是完全可以得到缓解症状和治愈。手术和非手术疗法,各有其特征,病人本身应对自身的疾病情况要有透彻了解,这种了解是熟悉症状的严重程度和神经、肌肉受损的性质,患者本人的身体、心理特殊情况,配合医生,选用合理的治疗方法,制订正规方案、计划周密、安排得当、循序渐进、从缓解症状治愈直到康复,避免方法不当加重病情或枉费时间与费用。
介入治疗系列
    椎间盘突出按照突出的多少划分为:椎间盘膨出、椎间盘突出、椎间盘脱出三种不同程度,在不同程度病人的表现各一,这样的划分主要以CT片或MRI片依据,椎间盘膨出及中度突出的病人,由于椎间盘纤维环未完全破裂,椎间盘髓核末突出椎管内,这样就为椎间盘突出的复位(回纳)提供了条件,DFQ-400B复位机以手法复位和机械复位原理。通过计算机精密控制,将病人固定后,定点定角度,定量定速度,采取屈背、斜扳、拉拨、侧弯、旋转复位等方法,使椎间隙增大,后纵韧带紧张,降低椎间盘内压力,使椎间盘外组织包括椎管,腹压增加,可起到类似吸吮作用,使膨出及突出的椎间盘回纳。临床经验我们用造影剂注入实验标本椎间盘内,然后分别对复位前、复位时、复位后的椎间盘摄片,当椎间盘开始复位时造影剂从椎间盘前方流向后方,当复位时力度加大时,造影剂向中央部位流入,去除复位后,造影剂滞留于椎间盘中央部位,这说明DFQ机械复位椎间盘突出的复位是安全,可靠有效的。

微创治疗系列
    腰椎间盘突出症的患者,95%同时会有腰椎管狭窄症,这是因为椎间盘组织突出向后方,压迫椎管硬膜囊,一侧或双侧侧隐窝狭窄,使受压部位水肿发炎,使椎管继发性变窄,这是一种继发性椎管狭窄症,解除压迫后可不同程度得以恢复。
手术治疗系列
    由于腰或颈椎间盘突出,使椎间孔部位神经根受压,引起神经根水肿,符着于神经的肌肉亦水肿发炎,有一种炎性液体渗出,肌肉和神经发生粘连,当抬腿及患肢活动时牵拉疼痛,要解除粘连必须实行粘连松解,所以神经粘连松解术应运而生,由临床经验丰富的医生,通过特殊的医疗器械,在神经与肌肉粘连的位置,随神经及肌肉的走行方向将粘连的部位松解开来,随后注入防止粘连的药物后,再抗炎消肿等对症处理,使水肿与炎症消失,神经与肌肉各行其道,而达到治愈目的。


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