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      風濕性疾病與股骨頭壞死

      發布時間:2019-09-26 21:15

        風濕性疾病是一組病因復雜,病理表現多樣的骨關節及其周圍軟組織的疾病,一般多發于氣候寒冷潮濕地區,在我國普遍存在,華南較少,往北漸多。風濕性疾病常常會引起不同程度的骨質改變,是股骨頭壞死的誘因之一。風濕性疾病常常會引起不同程度的骨質改變,是股骨頭壞死的誘因之一。臨床上風濕性疾病合并股骨頭壞死常見于兩大類:強直性脊柱炎(簡稱AS)合并股骨頭壞死,類風濕性關節炎(簡稱RA)合并股骨頭壞死。 

        股骨頭壞死 

       股骨頭缺血性壞死是骨科的一大頑癥,俗稱不死的癌癥。發病有上升趨勢,不分老幼。早期難確診,患者有側臀部痛疼,腹股溝痛,股膝關節局部痛疼,活動時極易疲勞。所以早期往往會誤診為勞累過度所致。隨著病情的發展,患者下肢痛疼跛形,活動受限,繼而發生股肌萎縮,給病人造成極大痛苦。在X光下,會看到表面粗糙,缺損塌陷,皸裂等不規則現象。發病原因主要有以下因素,長期飲酒或用激素藥物引起,也有創傷或手術引起,勞累過度或風濕邪毒侵入也會引起,其它如髖關節發育不良,骨關節病,妊娠等也會引起此病。這些因素影響了肝脾腎的正常功能,使肝臟虧損,外邪乘虛而入,造成氣血不足而瘀滯,局部血液循環受阻,股骨頭缺乏營養導致壞死。不少患者采取西醫治療,如手術、打針、減壓、藥物注射、血管植入等法治療,都無顯著療效,給病人造成極大痛苦和不必要的經濟負擔。特別是置換人工髖關節,手術更是昂貴。這些療法是大多數可以非手術治愈的患者,卻因手術不佳而造成醫源性終生殘疾。

       
              什么是股骨頭壞死 

       股骨頭壞死又稱幼年性畸形性骨軟骨炎,股骨頭上端骨骺壞死,扁平髖等。約99%為單側發病,而雙側病變極少,且不會同時發病。易發于312歲兒童,男孩多于女孩。其主要病理改變,是因股骨頭血液循環障礙,而出現的運行性改變,跛行、疼痛。凡是因外傷或其他病變所引起的骨骼的血液循環障礙,不能迅速代償或修復者,均可造成骨壞死。骨壞死目前臨床上把股骨頭缺血性壞死列為主要的治療對象,而忽略了其他部位,使其他關節失去了最佳的治療時期,導致關節畸形‘功能受限等癥狀。據統計:患股骨頭壞死的占100%,患膝關節壞死95%,肩關節壞死80%,踝關節壞死占45%。其他小關節有:手腕的月骨,腳上的距骨等部位均有發病。 


             股骨頭壞死的發病情況如何 

       1888年世界醫學界首次認識股骨頭壞死這一疾病至今,股骨頭壞死已由少見病轉變為多發病、常見病。尤其是激素的問世及其廣泛應用以來,股骨頭壞死的發病率逐漸上升。加之交通事故的增多,人們生活方式的改變,均使該病患者數量增加。據不完全統計,目前全世界患此病者約3000萬人,我國約有400萬人。最新的調查表明,該病的發生無明顯性別差異,任何年齡均可患病,而有過激素應用史、髖部外傷史、酗酒史、相關疾病史者發病的機率明顯增多。 


        股骨頭壞死的病因是什么 

       (一)創傷性
         ①由于髖部外傷后,股骨頸骨折,髖關節脫位。

        ②兒童多因蹲傷、扭傷或半脫位所致的?;蚣葲]有骨折,又沒有脫位的血管支損傷,均可造成股骨頭缺血壞死。
       ?。ǘ┓莿搨?/span>
       ?。?/span>1)長期或大量應用糖皮質激素占43%
       ?。?/span>2)酒精中毒
       ?。?/span>3)減壓病
         潛水、飛行人員在高壓情況下,血液和組織中溶解的氮增加,環境壓力降低時,已溶解的超量氮需逐漸經由肺部排出,若壓力降低過快,氮氣來不及排出,即在體內游離出來,形成氣泡,產生氣體栓塞,氣體栓塞在血管,血流受阻,股骨頭局部血供變差,缺血壞死。
       ?。?/span>4)其他
         高血壓、糖尿病、動脈硬化、肥胖癥、痛風、放射治療、燒傷后,也可造成股骨頭壞死。 


        股骨頭壞死的高危人群有哪些 

       1)長期應用激素類藥物
        由于患者病情不穩定,需要長期大量服用激素類,如:強地松、地塞米松及皮質激素等藥物。一般可導致雙側股骨頭壞死。
       ?。?/span>2)長期大量飲酒者
        隨著社會的發展,人們的交往日益頻繁,長期大量的飲酒有時也在所難免,而嗜酒者則對酒情有獨鐘,喝起酒來沒有節制。
       ?。?/span>3)有過髖部外傷史者
         交通事業的飛速發展,交通工具有日新月異,交通事故的發生率也在逐年增加,生活、工作、運動中不慎而造成的股骨頸骨折、髖關節脫位或無骨折脫位的髖部外傷均可造成股骨頭供應的血管受到損傷,為股骨頭壞死埋下了隱患。其股骨頸骨折并發股骨頭壞死者最為多見。
       ?。?/span>4)其他
         潛水、飛行人員、肥胖癥、高血壓、糖尿病、動脈硬化、痛風、需接受放療者、燒傷后、血紅蛋白病等,也是容易發生股骨頭壞死的高危人群。


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