摘要
患者男,47岁。左膝关节肿胀伴畸形8个月。自3年前遇冷热时T12以下有针刺感和紧缩感,行走时有漂浮感,以闭眼时显著,8月前无明显诱因左膝关节出现无痛性肿胀。体检:皮肤黏膜未见异常。Romberg征阳性,肱二头肌及肱三头肌反射迟钝,膝、踝反射消失,下肢关节震动觉、运动觉减退,左膝及左踝关节肿胀畸形。梅毒血清学检查示:RPR(+)和TPPA(+)。脑脊液检查示:白细胞计数及蛋白含量升高,脑脊液压力正常,TPPA(+)。左膝关节X线示:左膝关节面结构异常,股骨下端、胫骨上端关节面破坏,呈虫蚀样。关节间隙狭窄,部分消失。髌骨韧带及关节囊周围有游离钙化碎骨片。组织病理示滑膜慢性炎性改变。诊断:脊髓痨;夏科关节病。
A 47-year-old man had presented with swelling and deformity of the left knee for 8 months.Three years ago,acmesthesia and tightness below T12 appeared when he touched cold or hot,floating feeling when walked,which was significant when eyes closed.No obvious incentive the left knee painless swelling 8 months ago.Physical examination：No abnormal findings were observed of skin or mucosa membranes.Romberg sign positive,biceps and triceps reflex retardation,knee and ankle reflexes absent,vibration sense and cinesthetic sense in lower limb joints decreased.The left knee and ankle swelling and deformity.Syphilis serological tests showed RPR and TPPA positive.CSF examination revealed cell counts and albumen were abnormal,CSF pressure was normal,TPPA positive.The X-ray of the left knee showed the structures of articular surface were abnormal.Distal femur and proximal tibia joint surface were worm-eaten-like change.The joint space is narrow,even partly disappeared.Free calcification bonebreaker film was seen around patellar ligament and joint capsule.Histopathology suggested chronic inflammatory changes in synovial.This case was diagnosed as tabes dorsalis with Charcot′s arthropathy.
出处
《中国皮肤性病学杂志》
CAS
北大核心
2010年第10期931-933,共3页
The Chinese Journal of Dermatovenereology
关键词
梅毒
脊髓痨
夏科关节
Syphilis
Tabes dorsalis
Charcot joint
