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上期试题：骨与关节结核最好发部位是b A．指关节 B．脊柱 C．踝关节 D．腕关节 E．骶髂关节 接上期内容： 腕关节结核多见于青少年，男性较女性多见，临床表现为局部软组织肿胀、疼痛及手指功能受限。影像上早期表现为腕部软组织肿胀、骨质疏松，进而出现局限性多发骨质破坏、关节间隙变窄等；晚期可导致全腕关节结核，并关节脱位、骨性强直以及畸形。腕关节结核应与下列病变进行鉴别： Wrist joint tuberculosis among teenagers, more men than women, clinical manifestations for the local soft tissue swelling, pain and limited function of fingers. Images on the early performance for wrist tissue swelling, osteoporosis, and limitations of multiple bone destruction, joint gap Narrows, etc.; Late can lead to the wrist joint tuberculosis, and joint dislocation, bony rigidity and deformity. Wrist joint tuberculosis should be identified and pathological changes of the following: 1、类风湿关节炎：该病病史较长，以20—40岁成年人多见，常对称性侵及全身多个关节，腕部是主要累及部位之一，以累及滑膜与软骨为主，双腕疼痛及关节普遍性肿胀为特点。影像学上主要表现为骨质疏松、关节面糜烂及小囊状骨缺损，多出现在骨的边缘。严重者亦可出现关节间隙变窄，腕关节可半脱位向尺侧偏斜。晚期腕关节强直和肌肉萎缩。一般不会出现脓肿、窦道或死骨形成。 1、rheumatoid arthritis: a long history of the disease, with 20-40 adults see more, often symmetry invasion and systemic multiple joints, wrist is one of the main affected parts, mainly involving the synovial and cartilage, double pain universality and joint swelling. Imaging on main performance for osteoporosis, joint surface erosion and capsule shape defects of bone, appeared at the edge of the bone. Severe cases may also appear narrow joint space, wrist joint subluxation lateral deflection to the feet. Advanced wrist joint stiffness and muscle atrophy. General won't appear of abscess, fistula and dead bone formation. 2、痛风性关节炎：该病为代谢障碍性疾病，特点是血清及体液中尿酸增高，尿酸钠结晶沉积 于小关节及其周围组织，以成年男性好发，临床上常突然发作，疼痛明显，可伴有关节红、肿、热及压痛。影像学上特点是好发于指（趾）间小关节，以第一趾跖关节最为好发，表现为局部软组织肿胀，可见关节边缘呈小囊状或卵圆形骨缺损区，界限清晰，无明显骨质疏松。以上改变与腕关节结核的影像学表现有所不同。 2、gouty arthritis, the disease of metabolic disorder is characterized by increased uric acid in serum and body fluid, uric acid sodium crystal deposition in the small joints and surrounding tissues, in adult male good hair, clinically often sudden onset, pain, redness, swelling, heat, and may be accompanied by joint tenderness. On imaging features are good hair at small joints between refers to (foot), in the first foot plantar joints is most good hair, characterized by local soft tissue swelling, visible edge joint capsule shaped or ovoid bone defect area, line is clear, no obvious bone loss. The above change and the imaging findings of wrist joint tuberculosis is different. 3、腕骨缺血性坏死：腕骨缺血性坏死主要见于腕部月骨或舟骨，亦称骨软骨炎。多见于20—30岁有外伤或劳损史者，男性对于女性，右侧多于左侧，表现为患侧腕部酸痛无力、活动受限、X线及CT表现为受累骨密度增高，可部分变形或不规则，可见裂隙；晚期受累骨出现碎裂，有时可见囊性变，关节间隙一般不狭窄，亦无其他骨质破坏及骨质疏松改变。 3、wrist avascular necrosis: carpal bone avascular necrosis or scaphoid bone, mainly in the wrist month also called osteochondritis. See more at 20 to 30 years old has a history of trauma or strain, male to female, right more than left, performance with contralateral wrist ache weakness, limited activity, X-ray and CT manifestations of bone mineral density increased, affected part deformation or irregular, visible cracks; Late affected bone fracture, sometimes visible cystic change, joint space is generally not narrow, there is no other bone destruction and osteoporosis. 医学博士专栏 第二十六期：来自伦道夫博士的建议之防止游泳耳病 彻底使外耳道干燥有助于预防游泳性耳病。如果你在游泳、淋浴或洗头发时外耳道进水，先彻底清除耳道积水。接下来，如果你的鼓膜没有穿孔而且最近也没有做过耳部手术，那么在一个小碗里混合等量的外用酒精（乙醇）和白醋（酒精用来把耳朵弄干，醋能改变外耳道的酸度，使细菌不能滋生）。然后，一只耳朝上，侧躺着，用医用滴管滴3—4滴刚调的混合液，保持耳向上并停几分钟。当然你也可以通过往下牵拉耳垂和开闭嘴的方式来让液体进入外耳道的更深处。几分钟后，你就可把头反向过来，倒出液体。对于另一只耳同样如此。 The external auditory canal dry thoroughly swimming can help prevent disease. If you are in the plane into the water when swimming, shower or wash your hair, thoroughly clean the ear canal water first. Next, if you're not perforation of tympanic membrane and recently also not done ear operation, so in a small bowl, mix equal amounts of rubbing alcohol (ethanol) and white vinegar (alcohol is used to dry the ear, vinegar can change the acidity of external auditory canal, the bacteria can't breed). Then, a ears up, lying on your side, with medical dropper 3-4 drops just adjust the mixture, maintain the ear up and stopped for a few minutes. Of course you can pull down the earlobe and open up the way to let the liquid into the external auditory canal deeper. After a few minutes, you can head back round, pour out the liquid. For the other ear. 本期试题：痛风易受累的关节？ A.膝关节、髋关节、踝关节 B.膝关节 C.腕关节、掌指关节、近指关节 D.第1跖趾关节 E.近端指间关节、腕关节、足部关节
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来自： zskyteacher > 《西航港之临床影像学习平台》
