神经性骨关节病、英文.ppt

Neuropathic osteoarthropathy represents a spectrum of bone and joint destructive processes associated with neurosensory deficit. diabetes mellitus syringomyelia syphilis and other neuropathies radiologic findings  Osteoarthritis Infection tumor Both hypertrophic and atrophic patterns of neuropathic osteoarthropathy are depicted radiologically. The classically described hypertrophic joint is manifested radiologically as joint destruction and fragmentation, osseous sclerosis, and osteophyte formation. The atrophic form of neuropathic osteoarthropathy has an appearance of osseous resorption that often gives the impression of surgical amputation. The atrophic type may appear similar to septic arthritis, and the hypertrophic type, as mentioned earlier, may appear similar to osteoarthritis. Joint disorganization and large persistent bloody joint effusion are features of both atrophic and hypertrophic types of neuropathic osteoarthropathy, and, when severe, both types exhibit disorganization more profound than that seen in other forms of arthropathy. Milder degrees of the disease, however, may be difficult to diagnose. Fractures are an important although less well-known manifestation of neuropathic osteoarthropathy. These fractures may occur spontaneously or in the presence of minor trauma. Neuropathic osteoarthropathy in the non–weight-bearing joints of the upper extremity is relatively rare compared with that in the lower extremity. The most common cause of a neuropathic shoulder is syringomyelia. Figure 1a. Neuropathic osteoarthropathy of the shoulder in a 45-year-old man with a syrinx. (a) Frontal (anteroposterior) radiograph depicts osteolysis resembling amputation with sharply circumscribed margins. Normal mineralization is maintained in the remaining humerus. Debris lines the distended joint capsule, subscapular recess (black arrow), and axillary recess (white arrow). (b) T1-weighted spin-echo magnetic resonance (MR) image (repetition time mse