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內(nèi)容簡介

　　在風(fēng)濕病學(xué)與骨科疾病的臨床診療中，脊柱關(guān)節(jié)炎及其相關(guān)疾病非常復(fù)雜，其多樣性令人感到極具挑戰(zhàn)。這些疾病的臨床表現(xiàn)復(fù)雜多變，極易與其他疾病混淆，常常導(dǎo)致誤診和延誤治療。因此，初學(xué)者急需一本能夠深入系統(tǒng)地探討這些疾病臨床診治的參考書籍。本書正是以豐富的案例和嚴(yán)謹(jǐn)?shù)膶W(xué)術(shù)態(tài)度向我們展示了如何在復(fù)雜的臨床情景中識別和管理脊柱關(guān)節(jié)炎及其相關(guān)疾病。本書的編排結(jié)構(gòu)從實際案例出發(fā)，涵蓋了典型的強直性脊柱炎和少見的晚發(fā)型脊柱關(guān)節(jié)炎、SAPHO綜合征、感染性疾病及罕見的腫瘤性骶髂關(guān)節(jié)病變等多種臨床表現(xiàn)相似的案例。這些案例不僅全面展示了脊柱關(guān)節(jié)炎及相關(guān)疾病的臨床面貌，還深入剖析了診斷過程中可能面臨的困境和“陷阱”。通過這些案例的細(xì)致分析，讀者不僅可以了解疾病的影像學(xué)特點、致病機制，還能夠掌握在不同情況下如何靈活應(yīng)對疾病診斷，從而提高自身診斷水平的方法。令人印象深刻的是，本書特別強調(diào)了在臨床診斷中的思辨過程和多維度的鑒別診斷。書中收錄的許多案例并非教科書中所描述的“典型病例”，相反，它們呈現(xiàn)出了復(fù)雜的臨床表現(xiàn)，如誤診為脊柱結(jié)核的強直性脊柱炎、疑似類風(fēng)濕關(guān)節(jié)炎的外周型脊柱關(guān)節(jié)炎等。這些案例生動地提醒我們，臨床診斷不僅僅依賴于影像學(xué)或實驗室檢查結(jié)果，更需要結(jié)合豐富的臨床經(jīng)驗和靈活的思辨能力。在面對復(fù)雜病例時，醫(yī)生的思維深度和廣度決定了診斷的準(zhǔn)確性。此外，本書對于罕見案例和疑難病癥的探討也極具價值，如少見的米粒體滑囊炎、腫瘤相關(guān)性低磷骨軟化癥，以及甲狀旁腺功能亢進癥相關(guān)低磷骨軟化癥等罕見疾病，這些內(nèi)容展示了筆者對臨床疑難案例的深入理解和解決能力，也為廣大臨床醫(yī)務(wù)工作者提供了極為寶貴的參考資料。總體來說，本書的出版無疑是風(fēng)濕病學(xué)與骨科領(lǐng)域的一項重要貢獻。它不僅填補了脊柱關(guān)節(jié)炎及相關(guān)疾病診治中某些知識領(lǐng)域的空白，也為我們提供了寶貴的臨床經(jīng)驗。這本書的內(nèi)容豐富、分析透徹，既適合一線臨床醫(yī)生作為日常診治的參考指南，也為從事相關(guān)研究的學(xué)者提供了深入思考和探索的機會。作為本書的主審，我深感榮幸，并誠摯地向風(fēng)濕病學(xué)、骨科及相關(guān)學(xué)科的醫(yī)務(wù) 工作者推薦本書。相信它不僅會拓寬我們的臨床視野，更能為患者帶來福祉。

作者簡介

　　黃烽主任醫(yī)師，教授，博士研究生導(dǎo)師。現(xiàn)任中國人民解放軍總醫(yī)院第一醫(yī)學(xué)中心風(fēng)濕免疫科名譽主任，全軍風(fēng)濕病中心主任，全軍醫(yī)學(xué)免疫學(xué)會副主任委員，中國中西醫(yī)結(jié)合風(fēng)濕病委員會副主任委員，《中華風(fēng)濕病學(xué)雜志》副總編。曾任國際強直性脊柱炎協(xié)會常務(wù)理事、中華醫(yī)學(xué)會風(fēng)濕病學(xué)分會副主任委員、中國醫(yī)師協(xié)會風(fēng)濕免疫分會副會長等。國家自然科學(xué)基金杰出青年基金和中國科協(xié)求是杰出青年獎獲得者，擁有 2 項國家發(fā)明專利，曾獲中華醫(yī)學(xué)科技獎一等獎、軍隊醫(yī)療成果獎一等獎，享受國務(wù)院政府特殊津貼。張江林主任醫(yī)師，副教授，碩士研究生導(dǎo)師。中國人民解放軍總醫(yī)院第一醫(yī)學(xué)中心風(fēng)濕免疫科主任醫(yī) 師?，F(xiàn)任北京醫(yī)師協(xié)會風(fēng)濕免疫?？漆t(yī)師分會副會長、北京醫(yī)學(xué)會風(fēng)濕病學(xué)分會副主任委員、中華醫(yī)學(xué)會風(fēng)濕病學(xué)分會委員。朱劍主任醫(yī)師，教授，博士研究生導(dǎo)師。現(xiàn)任中國人民解放軍總醫(yī)院第一醫(yī)學(xué)中心風(fēng)濕免疫科主任，北京醫(yī)學(xué)會風(fēng)濕病學(xué)分會委員，北京醫(yī)學(xué)會內(nèi) 科學(xué)分會常務(wù)委員，中國初級衛(wèi)生保健基金會風(fēng)濕免疫學(xué)專業(yè)委員會脊柱關(guān)節(jié)炎工作委員會副主任委員，中國醫(yī)療保健國際交流促進會風(fēng)濕免疫病學(xué)分會常務(wù) 委員。曾獲軍隊醫(yī)療成果獎一等獎。冀肖健主治醫(yī)師，醫(yī)學(xué)博士。中國人民解放軍總醫(yī)院第一醫(yī)學(xué)中心風(fēng)濕免疫科主治醫(yī) 師。從事風(fēng)濕病臨床工作，主持北京市自然科學(xué)基金1項，參與多項國家及軍隊基金項目，以第一 / 共同第一作者發(fā)表論文 20 篇，參編圖書 2 部，參譯圖書 1 部。趙玉榮副主任醫(yī)師。中國人民解放軍總醫(yī)院第一醫(yī)學(xué)中心風(fēng)濕免疫科副主任醫(yī)師。從事臨床及教學(xué)工作多年，以第一作者在核心期刊發(fā)表論文 3 篇，統(tǒng)計源論文 1 篇，參與編寫論文 10 余篇。

圖書目錄

脊柱關(guān)節(jié)炎案例1 髖痛-背痛-頸部活動受限 ························································ 2 案例2 老年男性-慢性腰痛-脊柱骨贅形成 ············································ 6 案例3 老年男性-慢性腰痛-虹膜炎 ····················································· 9 案例4 胸痛-發(fā)熱-腰背痛-多關(guān)節(jié)腫痛 ··············································· 14 案例5 臀區(qū)痛-前胸壁疼痛-左膝腫痛 ················································· 18 案例6 臀區(qū)痛-CRP升高-PPD試驗強陽性 ············································ 22 案例7 腰背痛-多關(guān)節(jié)腫痛-持續(xù)右肩腫脹 ··········································· 26 案例8 腰背痛-頸部疼痛-摔傷后加重 ················································ 29 案例9 臀區(qū)痛-腰痛-負(fù)重后加重 ······················································· 32 案例10 腰背痛-關(guān)節(jié)痛-頸部活動受限 ··············································· 35 案例11 炎性腰背痛-多發(fā)骨橋-咳嗽后機械性腰背痛 ····························· 39 案例12 腰背痛-周身疼痛-腰椎三柱病變 ············································ 44 案例13 臀區(qū)痛-左膝腫痛-低熱 ························································ 48 案例14 交替性雙髖疼痛-腰背痛-發(fā)熱 ··············································· 51 案例15 青年男性-寡關(guān)節(jié)炎-抗環(huán)瓜氨酸肽抗體陽性-關(guān)節(jié)結(jié)構(gòu)破壞 ·········· 55 案例16 腰背痛-多關(guān)節(jié)腫痛-發(fā)熱 ····················································· 59 與脊柱關(guān)節(jié)炎有類似表現(xiàn)的其他風(fēng)濕性疾病案例17 間斷腰痛-胸鎖關(guān)節(jié)腫痛-掌跖膿皰病 ······································ 64 案例18 胸痛-手足膿皰-慢性髖關(guān)節(jié)痛 ··············································· 68 案例19 右髖痛-骨肥厚-痤瘡-膿皰病 ················································· 72 案例20 腰痛-左腿疼痛-右鎖骨區(qū)疼痛-雙手皮疹 ·································· 77 案例21 發(fā)熱-多關(guān)節(jié)腫痛-骨破壞-白細(xì)胞減少 ····································· 81 案例22 踝痛-臀區(qū)痛-腰背痛 ··························································· 87 案例23 發(fā)作性關(guān)節(jié)腫痛-腰痛-高尿酸血癥 ········································· 90 案例24 多關(guān)節(jié)腫痛-頸部疼痛-鞏膜藍染 ············································ 93 案例25 肘關(guān)節(jié)活動受限-膝痛-髖痛 ·················································· 98 案例26 頸后區(qū)疼痛-外周關(guān)節(jié)疼痛 ·················································· 102 需與脊柱關(guān)節(jié)炎相鑒別的感染性疾病案例27 臀區(qū)疼痛-腰背痛-發(fā)熱 ······················································ 108 案例28 反復(fù)發(fā)熱-關(guān)節(jié)腫痛-非甾體抗炎藥效果欠佳 ···························112 案例29 臀區(qū)痛-發(fā)熱-呼吸困難-骶髂關(guān)節(jié)炎 ·······································116 案例30 發(fā)熱-頸痛-胸痛-背痛 ························································ 120 案例31 腰背痛-發(fā)熱-骶髂關(guān)節(jié)炎 ··················································· 123 案例32 肌痛-指端潰瘍-右膝關(guān)節(jié)腫痛 ············································· 126 案例33 雙手遇冷變白-多關(guān)節(jié)疼痛-下肢無力 ···································· 130 需與脊柱關(guān)節(jié)炎相鑒別的腫瘤性疾病案例34 發(fā)熱-臀區(qū)痛-全血細(xì)胞減少-淋巴結(jié)腫大 ································ 136 案例35 腰背痛-關(guān)節(jié)痛-嗜酸性粒細(xì)胞增高-骶髂關(guān)節(jié)炎 ······················· 139 案例36 血細(xì)胞減少-腰背痛-發(fā)熱 ··················································· 143 案例37 右髖疼痛-低熱-腰背疼痛 ··················································· 148 案例38 多關(guān)節(jié)屈曲-多關(guān)節(jié)腫脹-駝背-張口受限 ································ 152 案例39 臀區(qū)痛-骶髂關(guān)節(jié)骨質(zhì)破壞-軟組織腫塊 ································· 157 案例40 腰痛-肌無力-蹣跚步態(tài) ······················································ 162 案例41 右上頜腫物-腰背痛-低磷血癥 ············································· 167 與脊柱關(guān)節(jié)炎有類似表現(xiàn)的其他中軸或關(guān)節(jié)疼痛案例42 多關(guān)節(jié)腫痛-腰背痛-高鈣血癥 ············································· 172 案例43 多發(fā)骨折-骨質(zhì)疏松-低血磷-低血鉀-皮下多發(fā)腫物 ·················· 177 案例44 腰部無力-晨僵-鴨步步態(tài) ··················································· 182 案例45 石化耳-旋頸受限-低血糖-高血鈣 ········································· 186 案例46 雙手指疼痛-關(guān)節(jié)旁異物 ····················································· 190 案例47 左髖疼痛-腰椎強直-多關(guān)節(jié)活動受限 ···································· 194 案例48 皮疹-發(fā)熱-臀區(qū)痛 ···························································· 198 案例49 腰骶痛-臀區(qū)痛-骶髂關(guān)節(jié)硬化 ············································· 204 案例50 先天性聽力喪失-腰骶痛-“夾心椎”改變 ······························ 207 案例51 踝關(guān)節(jié)腫痛-腹股溝疼痛-腰痛 ··············································211 案例52 指間關(guān)節(jié)膨大-右膝疼痛-步態(tài)異常 ······································· 216 后記 221