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題 名 | 分娩後的化膿性薦腸骨關節炎:一病例報告及其核磁共振造影特徵=Postpartum Pyogenic Sacroiliitis: A Case Report with Magnetic Resonance Imaging |
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作 者 | 林仙明; 柯德鑫; | 書刊名 | 內科學誌 |
卷 期 | 9:4 1998.12[民87.12] |
頁 次 | 頁214-218 |
分類號 | 415.954 |
關鍵詞 | 化膿性薦腸骨關節炎; 分娩後; 核磁共振造影; Pyogenic sacroiliitis; Postpartum; Magnetic resonance imaging; |
語 文 | 中文(Chinese) |
中文摘要 | 在分娩後發生化膿性薦腸骨關節炎非常少見。在臨床上難於診斷。主要因為該疾 病較不常見,薦腸骨關節在人體的較深部,較不容易觸摸到,醫師的警覺性較低。而且傳統 的放射線診斷技術和 X 光,核子醫學, 電腦斷層攝影,在診斷上較有缺點,在臨床上未能 確實告知病變所在。本文報告一位 21 歲女性病人在 20 天前,曾接受過帝王式切開術生下 一健康男嬰。因最近二天發燒及左側腎部劇痛並放射至左下肢而住院。神經學檢查發現左側 大腿肌肉萎縮,左側踝反射減少,薦骨部神經正常,針刺痛覺反射正常,疑是左側第四腰椎 神經根病變。 但經腰椎之核磁共振造影 (MRI) 並無異常發現。 實驗室檢查發現白血球 7600/mm �纂A紅血球沉降速率 44 mm/hr,血液細菌培養發現葡萄球菌。 由於左側腎部疼痛 加劇,且無法自由行動。再重覆理學檢查發現左側薦腸骨關節處有明顯壓痛及局部溫度明顯 升高。 Patrick's test 呈現陽性反應,疑為薦腸骨關節病變,再度進行以 Gadolinium 顯 影劑加強後之骨盆 MRI 檢查,並發現左側化膿性薦腸骨關節炎。 經靜脈注射 Prostaphlin 每天 8gm 共一週,再追加 Dicloxacillin 每天 1000 mg 口服共三週後, 病人可以自由活 動。本文強調正確之診斷,需要臨床醫師對該疾病有高度警覺性,加上經顯影劑加強後之骨 盆 MRI 檢查能早期找出骨盆深部的化膿性薦腸骨關節病灶。 |
英文摘要 | Postparum pyogenic sacroiliitis is uncommon and is often dfficult to diagnose because of the rarity of the disorder, relatively inaccessibility of the sacroiliac joint, low clinical suspicion on the part of the physicians, and inadequate physical examination. The traditional imaging techniques for diagnosis are roentgenography, scintigraphy and computed tomography, all of which are of limited diagnostic value. We report a 21-year-old woman presented with fever and left buttock pain radiating to the left leg. She was 20 days postpartum and had received cesarean section delivery. Neurological examinations showed mild atrophy of the left thigh muscles, decreased ankle jerk, sparing of sacral nerve, normal pin-prick test which led to the tentative diagnosis of the left fourth lumbar nerve radiculopathey. However, magnetic resonance imaging of lumbar spine showed normal findings. Laboratory examinations showed a leukocyte counts of 7600/mm ��, erythrocyte sedimentation rate of 44 mm/hr, blood cultures yielded staphylococcus aureus. Because left buttock pain aggravated which impaired ambulation, repeated physical examinations showed there was extreme tenderness in the left sacroiliac joint with local heat. Patrick's test of the left hip showed positive which was suggestive of sacroiliitis. Gadolinium enhanced MRI of pelvic bone showed evidence that was compatible with the left pyogenic sacroiliitis. The patient was treated with prostaphlin 8 gm/day intraveneously for 1 week followed by dicloxacillin 1 gm/day for 3 weeks were administered. After this, the patient was ambulatory and can perform daily activities without buttock pain. |
本系統中英文摘要資訊取自各篇刊載內容。