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中华肩肘外科电子杂志 ›› 2023, Vol. 11 ›› Issue (02) : 161 -165. doi: 10.3877/cma.j.issn.2095-5790.2023.02.012

病例报告

脊髓空洞症合并夏科氏肩关节病且合并肩胛骨病理性骨折一例报告
张马莉, 刘远, 曾塬杰, 王靖()   
  1. 410005 长沙,湖南师范大学附属第一医院湖南省人民医院骨关节与运动医学科
  • 收稿日期:2023-01-07 出版日期:2023-05-05
  • 通信作者: 王靖
  • 基金资助:
    湖南省科技厅重点研发计划项目(2020SK2117)
  • Received:2023-01-07 Published:2023-05-05
引用本文:

张马莉, 刘远, 曾塬杰, 王靖. 脊髓空洞症合并夏科氏肩关节病且合并肩胛骨病理性骨折一例报告[J]. 中华肩肘外科电子杂志, 2023, 11(02): 161-165.

夏科氏关节病,由Charcot于1868年首先描述,也称为Charcot关节病,临床上较少见[1]。脊髓空洞症是导致上肢关节病最常见的原因,20%~40%的脊髓空洞症患者伴有关节受累,最常累及肩关节[2]。目前为止,只有极少数文献报道脊髓空洞症引起的夏科氏肩关节病,对于该病的病理生理学、临床表现及治疗的了解十分有限[3]。而夏科氏肩关节病同时合并肩胛骨骨折的情况更加罕见。本院收治脊髓空洞症合并肩关节夏科氏关节病且合并肩胛骨病理性骨折1例,报告如下。

图1 入院时可见右侧手背较左侧稍肿胀
图2 右肩关节主动活动受限 图A:前屈130°;图B:外展110°
图3 X线片示右肱骨头及肩胛盂骨质破坏明显,右肩关节间隙不规则增宽,右肩关节呈半脱位状态
图4 右肩MRI 图A:右肩关节周围软组织改变,右肩关节积液,右肩袖损伤;图B-C:右肩关节及肩胛骨骨质改变
图5 右肩CT 图A:右肩胛骨骨折,右肩关节半脱位;图B-C:右侧肱骨头及肩胛骨关节面骨质异常,右肩关节半脱位
图6 颈椎MRI可见C1-T5椎体水平颈胸髓内长条片型信号改变,提示脊髓空洞
图7 随访显示 图A:患者右上肢肿胀较前无明显减退;图B:右手相比对侧肿胀明显
图8 随访显示右肩关节主动活动受限较前明显 图A:前屈90°;图B:外展90°
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