SACROILEITIS

From Big Medical Encyclopedia

SACROILEITIS (Latin [os] of sacrum a sacrum + (os) of ilium an ileal bone + - itis) — an inflammation of a sacroiliac joint.

It is observed preferential at mature and advanced age as a complication of osteomyelitis of pelvic bones (banal S.), at peripheral forms of a disease of Bekhterev, a brucellosis, bone and joint tuberculosis. At osteomyelitis of pelvic bones of S. it is most often caused by transition of inflammatory process from an ileal bone to a sacroiliac joint. Tubercular S. arises quite often owing to a hematogenous drift of causative agents of tuberculosis. Occasionally the joint is kontaktno surprised the extending congestive abscess at a spondylitis or a coxitis. At a brucellosis and Bekhterev's disease there is a hematogenous drift of an infection generally in soft tissues of a joint to secondary involvement in process of joint surfaces of a joint.

At acute purulent (banal) S. against the background of the serious condition connected with acute manifestations osteomyelitis (see) an ileal bone or a sacrum, there is a repeated attack of pains in a joint, infiltration of soft tissues or an abscess come to light. The palpation of a joint is sharply painful. At rectal and vaginal examonation quite often it is possible to palpate intra pelvic abscess.

The long anamnesis, an illegibility a wedge, manifestations, the low-expressed a sacroiliac joint pain are characteristic of tubercular and brucellous S., and also S. at Bekhterev's disease. The proximity of lumbar and sacral textures defines the irradiating nature of pains. At survey reveal the lameness connected generally with pains on the party of defeat. A valuable diagnostic character is the symptom of Trendelenburga (see. Hip joint ), connected with weakness of gluteuses on the party of defeat. At a palpation morbidity of back departments of a joint is noted, at a rectal research — front departments. At S. reveal a positive symptom of Kushelevsky (the prelum or cultivation of wings of ileal bones causes a sacroiliac joint pain), Genslen's symptom (in a dorsal decubitus at the bent healthy leg and the patient lowered for the table edge a sacroiliac joint pain on the party of defeat develops), Krasnobayev's symptom (at serial bending of legs lying on spin in case of damage of a sacroiliac joint pain in it develops earlier, than the hand inspecting, enclosed under a waist of the patient, will feel the movement of a backbone), Ingelrans's symptom (in a dorsal decubitus of the patient can raise only slightly straightened leg because of pains on the party of defeat).

The diagnosis is established on the basis of data clinical and rentgenol. researches, and at tubercular and brucellous S. also by results serol. researches. Quite often S. is the only precursory symptom of a brucellosis and Bekhterev's disease, and his recognition helps to make the diagnosis of these diseases.

For S.'s radiodiagnosis, as a rule, it is enough to carry out a X-ray analysis of a sacrum with both sacroiliac joints in a direct projection. Sometimes for specification of a condition of joint surfaces and identification of the centers of destruction resort to additional shooting of each joint with turns of the patient and to tomographies (see). S.'s radiodiagnosis is based on identification of an illegibility of contours of joint surfaces, narrowings of a joint crack, destruction in bones, a subchondral osteosclerosis. These signs in different combinations meet at S. of various etiology. As well as at other diseases, changes of a joint and the bones forming it are characteristic of Bekhterev's disease. The expressed destruction in the jointed bones does not manage to reveal even in special projections and on tomograms; the closing plates of joint surfaces of bones disappear, their contours become indistinct, the joint crack is narrowed. Before a characteristic bone anchylosis the diffusion zone of a subchondral osteosclerosis against the background of osteoporosis is always defined. At development of an anchylosis osteosclerosis (see) gradually is replaced osteoporosis (see).

At purulent or tubercular S. the ileal bone and a sacrum are always affected, the joint crack has indistinct contours; at tubercular S. the center of destruction in one of bones of a joint is always defined. At brucellosis (see) the osteosclerosis of a zone of a joint prevails, it is quite often possible to note narrowing of a joint crack and superficial destruction of the jointed bones from a joint.

The differential diagnosis is carried out with a pain syndrome at a joint form sacralization (see), and also with various diseases of lumbosacral department backbone (see).

Treatment at brucellous S. conservative. Vnutrikozhno in the field of a joint enter a vaccine or brucellin into several points (in the accruing doses). At Bekhterev's disease (see. Bekhtereva disease ) S.'s treatment consists in performing analgetic and antiinflammatory therapy (reception of Butadionum, Rheopyrinum, Pyrabutolum, etc.).

At banal and tubercular S. include an operative measure in complex treatment (antibiotics, streptocides, an immobilization), a cut carry out under anesthetic access on Bardengeyera — Pique — to Voyno-Yasenetsky. At the same time the section is carried out from the middle of a crest of an ileal bone to a posterosuperior awn, then on the course of a sacroiliac joint and in its lower part — knaruzh on the course of fibers of a big gluteus. Then carefully dissolve fibers of a big gluteus not to injure an upper buttock artery, and bare the lower specks of big sciatic cutting.

the Diagrammatic representation of the right half of a basin (back view) at a resection of a sacroiliac joint concerning a sacroileitis: the black line showed the direction of an osteotomy at an arthrectomy on Bardengeyera (a) and an economical P-shaped resection across Pokotilov.

At initial manifestations of purulent S. make urgent opening of purulent zatek and a resection of adjacent sites of a sacrum or a basin (see. Sacroiliac joint ). At hron. banal S. with big changes in a joint in a planned order carry out its resection on Bardengeyera — removal of back department of a wing of an ileal bone and a resection of a joint surface of a sacrum (fig., a). At tubercular S. with frequent localization of the center of destruction in the bottom of a joint the economical arthrectomy across Pokotilov is shown (fig., b): P-shaped excision of the bottom of a joint with an additional scraping of the adjacent changed sites of bones. This operation does not break a continuity of a pelvic ring, after it carry out long antibacterial therapy.

The forecast depends on a basic disease, timeliness and radicalism of its treatment.



Bibliography: Voyno-Yasenetsky V. F. Sketches of purulent surgery, L., 1956; Zedgenidze G. A., Gratsiansky V. P. both With and in e the Tax Code about F. F. Radiodiagnosis of kostnosustavny tuberculosis, L., 1958; Kornev P. G. Surgery of bone and joint tuberculosis, p. 2, page 324, L., 1971; About t are and e in I. B. and About t and p and e in and B. I. K to diagnosis and treatment of brucellous sacroileites, Owls. medical, No. 3, page 150, 1975; P about to about t and l about in K. E. Rol of operative measures of radical type at treatment of bone and joint tuberculosis, M., 1959; Reynberg S.A. Radiodiagnosis of diseases of bones and joints, book 1 — 2, M., 1964; Sat down also in An about in V. P. and In about r about N I am a N with to and y Yu. P. Osteomiyelita of a basin, M., 1975; They are of e r I. L. and Dyachenko V. A. Radiodiagnosis of diseases of a backbone, M., 1971; Chepy V. M. Bolezn Bekhtereva (ankylosing spondylarthritis), M., 1976, bibliogr.; In of wasps of h e r J. Wirbelsaulenleiden und ihre Differenzialdiagnose, Stuttgart, 1962; Kastert J., Diirkheim B. u. Uehlinger E. Skelettuberkulose, in book: Handb. der Tuberkulose, hrsg. v. J. Hein u. a., Bd 4, S. 443, Stuttgart, 1964.


Ya. B. Yudin; P. L. Zharkov (rents.).

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