Degenerative sacroiliitis
Introduction
Introduction to degenerative ankle arthritis Under normal circumstances, the ankle joint has a stable auricular joint surface, and there is strong ligament protection around it. Generally, external force is not easy to cause damage, but as the human body matures and ages, the body is in a bad position and muscle. In the case of imbalance, it is easy to cause or accelerate the strain of the ankle joint. Therefore, in the middle-aged and elderly people, the ankle joint is more prone to degeneration due to the relaxation of the ligament and the dislocation of the articular surface, especially in the prolific, middle Women after the year. basic knowledge The proportion of the disease: the middle-aged and elderly people over 50 years old are more common, the incidence rate is about 0.02%-0.03% Susceptible people: no specific population Mode of infection: non-infectious Complications: ankle joint tuberculosis
Cause
Degenerative ankle arthritis
(1) Causes of the disease
Under normal circumstances, the articular surface of the ankle joint is covered with hyaline cartilage, with synovial membrane, joint space and synovial fluid, and the activity is relatively small. The thickness of the articular cartilage surface of the tibia is only 1/3 of the articular cartilage surface of the tibia. Small general injuries can cause ankle arthritis.
(two) pathogenesis
The ankle joint can maintain its normal joint structure before the age of 30. Later, due to repeated general trauma or excessive load, the hyaline cartilage surface becomes fibrocartilage surface. This degenerative process can promote the bony of the ankle joint. Arthritis-like changes, severe cases can develop to ossification, especially in the elderly, the ankle joint subchondral bone can form a sclerosing change, and there is bone hyperplasia at the lower end of the joint, and even the formation of bone spurs, there is fashion Small cystic areas can be found.
In the pelvic cavity, because the lumbosacral trunk of the iliac crest spans the lower 1/3 of the front of the ankle joint, and only the joint capsule is separated, the sciatic nerve can be stimulated when the ankle joint is hyperplastic or has tumor and inflammation. Radiation pain in the lower limbs.
Prevention
Degenerative ankle arthritis prevention
Avoid fatigue
Grasp the time of work. Try to avoid standing and walking for a long time, because this will increase joint strength and accelerate joint degeneration, so be careful not to be too tired.
2 avoid overweight
Don't be too obese, because once you get fat, it will lead to the failure of all functions, so be sure to hold it on your weight. Moreover, after the weight is reduced, the pressure on the joint can be alleviated, and the damage of the joint can be prevented or reduced, which is helpful for the prevention and treatment of the disease.
3 to avoid traumatic infection
Trauma is also the cause of arthritis, so it is necessary to promptly and properly deal with the primary disease such as joint trauma, infection, osteoporosis after trauma.
Complication
Degenerative ankle arthritis complications Complications, ankle joint tuberculosis
Degenerative changes can cause changes in osteoarthritis in the ankle joint, and severe ossification can be achieved.
Symptom
Degenerative ankle arthritis symptoms Common symptoms Joint pain Ankle joint pain Joint swelling and intermittent claudication
The disease is more common in middle-aged and elderly people, especially women, mainly in the local pain and tenderness of the ankle joint, and with the distribution of nerve endings to the outer side of the femur and the upper third of the thigh, double When the foot is standing, due to the weight of the healthy limb, the affected side can be in a relaxed state, which is a flexion posture. When walking, the buttocks are drooping due to the pain of the affected side, and there are limp, the degree of pain and the lower limbs when sitting. The degree of restriction is lighter than when standing.
Special inspection:
1. Piedallu sign: The patient takes the sitting position, and the examiner observes whether the upper spine is at the same level from the rear. In general, the affected side is low; when the lumbar flexion occurs, the affected side is elevated more than the healthy side. .
2. Antagonistic hip abduction test: positive.
Examine
Examination of degenerative ankle arthritis
X-ray films mainly showed degenerative signs, and the manifestations of degenerative changes occurred depending on the course of the disease.
Diagnosis
Diagnosis and differentiation of degenerative ankle arthritis
Diagnostic criteria
There is no difficulty in the diagnosis of this disease, mainly based on the following points:
1. History: After the middle-aged onset, the main part of the pain is a bilateral pain; patients may have a history of different severity of trauma.
2. Clinical manifestations: high incidence in middle-aged and elderly, especially in women, local tenderness and cramps.
3. Imaging findings: Mainly on the X-ray film showing degenerative signs, depending on the course of the disease, the performance of degenerative changes in various stages, mainly hyperplasia and spurs.
Differential diagnosis
The disease is mainly differentiated from various diseases that cause pain in the ankles and buttocks, especially the following four types of lesions:
1. Tonic ankle arthritis: This disease is more common, especially in young people, but the disease has the following characteristics:
(1) Pain: From the beginning of the ankle joint, gradually to the upper vertebra, more sexually aggressive development.
(2) Bilateral: The ankle joint lesions are mostly bilateral symmetry, and invade the whole joint. The joint space is blurred to destruction, and finally the joint gap disappears.
(3) At the same time, the spine is involved: in addition to the ankle joint, the intervertebral joints of the spine are also invaded, and the vertebral segments in the later stage are bamboo-like changes.
(4) Others: The patient's blood cell sedimentation rate is fast, and the rheumatoid factor and other test indicators are mostly positive.
2. Ankle joint tuberculosis: It is also more common in clinical practice. Its characteristics are as follows:
(1) It is often unilateral: it infringes on the unilateral joint, and the lesion is mainly located in the lower part of the joint.
(2) lesions: tuberculosis lesions occur in the bones of the humerus or humerus, first for local bone destruction, then spread to the joints, causing gaps to widen and form dead bones.
(3) Cold abscess: When the ankle joint tuberculosis, such as pus gathers under the iliac ligament, it can flow along the psoas muscle to the thigh; it can also be penetrated from the ischial hole to the deep gluteus maximus, under the piriformis Down the sciatic nerve to the back of the thigh or the greater trochanter; in a few cases the infection can spread to the ischial rectal fossa.
3.Reiter disease: This disease is rare, clinically there are triads, that is, ankle joint, knee and foot arthritis, urethritis, and conjunctivitis, general urethritis first attack, arthritis is often asymmetrical, X-ray films showed joint surface destruction, and the surrounding bones were hardened.
4. Brucella arthritis: clinically there are ankle and multiple joint pain, fever, liver, spleen, lymphadenopathy, and Brucella agglutination test positive, X-ray film is mostly asymmetrical double The lateral joints are involved. At the beginning, the joints are loose, and the subchondral bones are absorbed, and the joint space is narrowed and hardened.
