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      強直性脊柱炎的危害、預防、治療

      發布時間:2019-09-26 21:20

       腰、頸、髖部疼痛,全身乏力,骶髂關節酸困,不適,發硬。腰前彎,后仰,左右側彎均受限。久站、久坐后僵痛加強。行走用力時及腰部轉動或姿勢不當時,均可使腰僵痛加重。劇烈疼痛發生在夜間,牽射致頸部、肋間、上肢、骶部、下肢,時常痛醒。只能起床活動后才能再次入睡。嚴重者見背、腰、頸、髖關節呈半固定狀態伴僵痛。最后導致頭部固定于前屈位,脊柱為"羅鍋",腰部為"乞求者"姿勢,骶髂部為"鴨式"步態,轉身時需整個身體轉動的"連軸轉",膝不能彎曲,髖不能抬起等嚴重畸形,很多方法治療效果均不顯著,部分治療顯效者又易反復,直至癱瘓。喪失生活能力,故強直性脊柱炎被俗稱“"不死的癌癥”。
          強脊炎雖然難以確診,但是臨床經驗豐富的??漆t師還是能夠盡早確診地!遺憾的是大部份早期確診患者,因臨床癥狀不是特別嚴重,僅是疼痛,多數患者盲目使用止痛藥治療,稍待疼痛好轉,就停止治療;而后反復發作,多次使用止痛藥,直至背、腰僵直,髖關節活動受限時才引起重視。但是這時已到強脊炎晚期,部分部位已殘廢,給治療帶來很大的難度。
      專家建議:15-30歲的青少年,背、腰疼痛伴早晨僵硬半年以上者,應及時到醫院拍骶髂關節正位X光片,若骶髂關節有改變者,即可確診為中、早期強脊炎。確診后應盡早接受正規治療,按規定鞏固一定的療程,絕大多數是可以完全治愈的!
      大腿內、外側痛,牽涉膝部或腰部疼痛半年,伴跛行,活動后加重,休息后減輕,CT片示:股骨頭有囊性變者,即可確診為早期股骨頭壞死。早期股骨頭壞死一般治療五個療程(一月一療程),即可完全治愈。

      強直性脊柱炎病人在什么情況下采取外科治療?

      盡管隨著現代醫學的發展,在強直性脊柱炎的治療上已經積累了很豐富的經驗,但至今為止世界上尚未發現某一種特效藥可以終止疾病的進一步發展;同時由于仍有很多醫生對本病的認識不清,常常造成誤診、漏診,使病人得不到及時治療,最終導致脊柱強直,面對已經強直的關節是不能用任何療法使其恢復的,因此對某些強直性脊柱炎病人需要手術治療。但手術治療也只是對癥治療,其目的是改善病人的功能,使他們能生活自理,提高生活質量。強直性脊柱炎的手術指征包括幾個方面:對有嚴重脊柱畸形的病人可作脊柱矯形手術(如胸椎、頸椎截骨術);對髖關節、膝關節活動明顯受限者,可采取關節置換或成形術,少數心瓣膜關閉不全嚴重者還需考慮換瓣術。

      強直性脊柱炎的病因是什么?

      強直性脊柱炎的病因尚未完全明確,目前認為與下列因素有一定關系:
         (1)基因因素:本病發病與遺傳因素有密切關系,強直性脊柱炎的HLAB27 陽性率高達90%96%,家族遺傳陽性率達23.7%。類風濕者其家族的發病率為正常人的21 0倍,而強直性脊柱炎家族的發病率為正常人的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,盆腔感染經淋巴途徑播散到骶髂關節再到脊柱,還可擴散到大循環而產生全身癥狀及周圍關節、肌腱和眼色素膜的病變。    

      (3)內分泌失調或代謝障礙:由于類風濕多見于女性,而強直性脊柱炎多見于男性,故被認為內分泌失調與本病有關。但利用激素治療類風濕并未取得明顯效果,激素失調與本癥的關系也沒有肯定。腎上腺皮質機能亢進的病人患類風濕或強直性脊柱炎的比率無明顯增加或減少。
         (4)其他因素:年齡、體質、營養不良、氣候、水土、潮濕和寒冷。其它包括外傷、甲狀旁腺疾病、上呼吸道感染、局部化膿感染等,可能與本病有一定關系,但證據不足。

       

      如何預防患上強直性脊柱炎

       強直性脊柱炎的病因與遺傳、感染、免疫、環境等因素有關。本病好發于男性,且20~30歲之間的男性是高發期,而在這一人群中與自己有血緣關系的近親,如有駝背、板狀背等變化的,而本人又是HLA-B27陽性者,則應特別警惕患上強直性脊柱炎,當然單純的HLA-B27陽性不會必然患上強直性脊柱炎,但這類人群中應積極預防腸道、泌尿系感染等,注意飲食衛生。注意泌尿生殖系統衛生,如出現上述疾病,則應積極抗感染治療,防止誘發強直性脊柱炎的發生。
               環境因素也是不可低估的誘因,因此這類人群在起居中一定要慎防風濕寒之邪,各季注意保暖,并且增強機體免疫功能。正氣內存,邪不可干,邪之所湊,其氣必虛,氣是指人的體質或抗病能力。機體正氣盛則能抵御風寒濕之邪的侵襲。如素體虛弱不足,或因情志、飲食、勞倦內傷而致氣血虛弱,則易患病。正如在同樣的致病條件下,有的人患病,有的人健康,便是這個道理。因此風寒濕邪,及一些感染源雖然是致病因素,但如果一個人機體抵抗力增強,則不一定患病。
               反之則風寒濕邪便可入侵經絡、筋脈,導致氣血不通而發病。故您平素應注意積極鍛煉身體,有一個健康的體魄,良好的心態,正確對待生活。不要因自己是強直性脊柱炎患病的危險人群,就憂心忡忡,消極生活。因為您并不必然患強直性脊柱炎,它也不是像血友病那樣毫無疑義的顯性遺傳。
      強直性脊柱炎的治療
                
      強直性脊柱炎的治療目標為:

      1.減輕疼痛,

      2.保持脊椎活動范圍及功能,

      3.并預防并發癥的發生。
              .患者教育與遺傳諮詢 強直性脊柱炎的病程通常是慢性、反反覆覆的,因此,讓患者了解疾病的病程、預後及可能的并發癥,并能充份地配合追蹤及治療是最基本的。醫師應適當地給予患者遺傳諮詢及生活型態的宣傳教育。睡眠干擾常是主要的問題,教導患者睡姿宜平躺或趴睡,枕頭宜低,床板宜硬,鋪約 五公分 厚之軟墊。 在遺傳諮詢方面,據統計,所有HLA-B27(+)的人,有2-10%終將發展成AS;若爸爸為AS患者,則小孩得AS之可能性約為10%。
               .運動及物理治療 運動對強直性脊柱炎患者是非常重要的。對減輕疼痛,保持脊椎活動范圍及增進生活質量皆有幫助。運動種類不限,原則上只要能活動關節的運動皆可----如柔軟體操、游泳、跳舞...等都是很好的運動。少數不動脊椎的運動(如自行車)及劇烈碰撞的運動(如拳擊)則應避免。 維持正確的姿勢也很重要,應避免長時間維持一個姿勢不動(""在沙發上看電視...);鼓勵患者多做伸展運動及伸張脊椎的運動,以預防脊椎的變形。
               .藥物治療 1. 消炎止痛藥(NSAID) 目的在減輕疼痛,使患者能多做運動,并增進生活質量;不能改變疾病的病程及活性。劑量可由患者根據疼痛程度自行調整給藥,以晨間僵硬為主的癥狀,可於睡前投與長效劑量??赡艿母弊饔脼椋耗c胃不適、水腫、腎功能障礙等。 2. 免疫調節劑 最常被使用的藥是「磺胺匹林」Salfasalazine,具有調節滿免疫系統的功用,可改變強直性脊柱炎的疾病活性。一般建議應早期使用,少數人使用後有副作用--主要是皮膚過敏、腸胃不適、肝功能障礙...等。 3. 特效治療特效治療“生物植入術”是針對強直性脊柱炎專方,既有明顯的消炎止痛作用,又有顯著的免疫調節作用。能快速減輕或消除炎癥性疼痛,改善以晨間僵硬為主的癥狀。適應癥包括: 1).40歲以前發病者, 2).疾病活性仍高時,3).有周邊關節炎及關節外癥狀、晨間僵硬者,4).發病初期1-10年內。 患者接受治療,3個月1療程,根據患者病情的不同,25個療程可達臨床治愈。 “生物植入術”能有效調節機體的免疫系統,改變強直性脊柱炎的疾病活性,阻止炎癥發展;改善鈣磷代謝,防治骨質疏松,阻止椎體變形;抑制成纖維細胞增殖,防治韌帶硬化、僵直,阻止脊柱強直;改善胃腸及肝腎功能,提高機體的抗病能力。 病程及預後 強直性脊柱炎的病程通常是慢性、反反覆覆的。評估疾病活性最好的指標是患者的癥狀。整體而言,只要積極的采用有效治療并多運動,強直性脊柱炎的預後是相當良好的,一般并不影響壽命(14)。百分之九十的患者仍然可以擁有良好的生活質量。預後不好的指標是:1.發病年齡小於十六歲,2.有周邊關節炎者,3.侵犯關節以外器官的患者,4.疾病活性常居高不下者。 結語 強直性脊柱炎是一個常見但卻容易被忽略的疾問題。經過詳細的詢問病史、理學檢查、X光攝影及醫師的警覺心,要診斷強直性脊柱炎其實并不難。尤其年輕人的反覆下腰痛,若并有晨間僵硬,應考慮強直性脊柱炎之可能。早期診斷及治療有助於改善病程并增進生活質量。治療原則為積極采用有效的治療方法(如:生物植入術、關節松解術)。一旦被診斷強直性脊柱炎,最重要的是嚴格按規定療程服藥治療并定期復診檢查,以避免脊椎變形及并發癥。

      治療特色

      非手術治療系列
          椎間盤突出癥的治療方法,取決于此病的不同病理階段和臨床表現,以及病人的身體和心理狀況。在醫學發展的今天,椎間盤突出癥的治療方法不外乎兩種:即非手術治療和手術治療。我中心在眾多的專 家 教授們多年的臨床努力下,在非手術治療領域走在全國乃至世界的前例。自1999"椎管擴張術""神經根松解術"兩種新方法運用于臨床之后,大大的提高了保守治療的治愈率,經過多年實踐證明,保守治療絕大多數腰椎間盤突出癥患者是完全可以得到緩解癥狀和治愈。手術和非手術療法,各有其特征,病人本身應對自身的疾病情況要有透徹了解,這種了解是熟悉癥狀的嚴重程度和神經、肌肉受損的性質,患者本人的身體、心理特殊情況,配合醫生,選用合理的治療方法,制訂正規方案、計劃周密、安排得當、循序漸進、從緩解癥狀治愈直到康復,避免方法不當加重病情或枉費時間與費用。
      介入治療系列
          椎間盤突出按照突出的多少劃分為:椎間盤膨出、椎間盤突出、椎間盤脫出三種不同程度,在不同程度病人的表現各一,這樣的劃分主要以CT片或MRI片依據,椎間盤膨出及中度突出的病人,由于椎間盤纖維環未完全破裂,椎間盤髓核末突出椎管內,這樣就為椎間盤突出的復位(回納)提供了條件,DFQ-400B復位機以手法復位和機械復位原理。通過計算機精密控制,將病人固定后,定點定角度,定量定速度,采取屈背、斜扳、拉撥、側彎、旋轉復位等方法,使椎間隙增大,后縱韌帶緊張,降低椎間盤內壓力,使椎間盤外組織包括椎管,腹壓增加,可起到類似吸吮作用,使膨出及突出的椎間盤回納。臨床經驗我們用造影劑注入實驗標本椎間盤內,然后分別對復位前、復位時、復位后的椎間盤攝片,當椎間盤開始復位時造影劑從椎間盤前方流向后方,當復位時力度加大時,造影劑向中央部位流入,去除復位后,造影劑滯留于椎間盤中央部位,這說明DFQ機械復位椎間盤突出的復位是安全,可靠有效的。

      微創治療系列
          腰椎間盤突出癥的患者,95%同時會有腰椎管狹窄癥,這是因為椎間盤組織突出向后方,壓迫椎管硬膜囊,一側或雙側側隱窩狹窄,使受壓部位水腫發炎,使椎管繼發性變窄,這是一種繼發性椎管狹窄癥,解除壓迫后可不同程度得以恢復。
      手術治療系列
          由于腰或頸椎間盤突出,使椎間孔部位神經根受壓,引起神經根水腫,符著于神經的肌肉亦水腫發炎,有一種炎性液體滲出,肌肉和神經發生粘連,當抬腿及患肢活動時牽拉疼痛,要解除粘連必須實行粘連松解,所以神經粘連松解術應運而生,由臨床經驗豐富的醫生,通過特殊的醫療器械,在神經與肌肉粘連的位置,隨神經及肌肉的走行方向將粘連的部位松解開來,隨后注入防止粘連的藥物后,再抗炎消腫等對癥處理,使水腫與炎癥消失,神經與肌肉各行其道,而達到治愈目的。


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