骨科
词汇介绍
拓展阅读
解析
costochondritis 英 [kɒstəʊ'kɒndraɪtɪs] 美 [kɒstoʊ'kɒndraɪtɪs]
释义 n. [医] 肋软骨炎
例句 Costochondritis is an inflammation at the junction of a rib and its cartilage.
肋软骨炎是一种肋骨和软骨连接区的炎症。
概述
一、疾病概述或定义
非特异性肋软骨炎，国外学者称 Tietzes 综合征，是胸痛的常见病因之一，患者常常因为胸部疼痛或者局部肋软骨肿胀前来诊治。同时又因为该病易复发且与乳腺科、普外科、心内科等胸疼症状疾病相混淆，困扰着患者及广大临床医生。
二、致病因素或病理机制
病因不明确，考虑：①大多数学者认为与肋软骨膜微小创伤及胸肋关节韧带和肋间内、外肌局部应力异常造成的劳损有关；②也有学者认为与上呼吸道病毒感染有关，导致胸肋关节面的软骨发生水肿，增厚而导致的无菌性炎症；③还有学者认为与免疫调节、内分泌异常引起肋软骨营养障碍有关。由于骨性胸廓解剖上的特点：肋骨左右共12对，由肋骨和肋软骨构成。肋软骨紧接于胸骨或肋骨的前端，由透明软骨构成，终生不骨化；而第1~4肋软骨单独存在并与胸骨相连，感染发生后一般不向邻近的肋软骨蔓延进展，第5~10肋软骨与相邻的软骨连接，形成肋弓并借以胸骨剑突与对侧肋骨相连，感染后炎症可通过此连接相互进展蔓延，使同侧及对侧肋软骨均发病。
三、症状表现
非特异性肋软骨炎在外科临床上颇为常见，占胸壁疼痛病因中的30％。非特异性肋软骨炎是一种以非化脓性肋软骨肿大及疼痛为突出表现的常见疾病，见于年青患者，左右侧发病率相似，单侧发病率较高，女性多见，好发部位为一侧 2~4 肋软骨。患者表现为上肢活动如拎重物时引发剧痛；咳嗽、咳痰、深吸气时诱发疼痛；又因疼痛不能正常呼吸而致胸闷、气促；也有表现为肋间刺痛或灼痛；也有疼痛放射同侧乳房、腋窝及同侧上肢；有的患者因疼痛难以缓解、反复发作而焦虑不安。
四、诊断方法
诊断要点：CT能很好地显示软骨肿胀及骨化，但无法显示骨膜下活动性炎。MRI能够显示骨、软骨、滑膜及骨髓的活动性炎性改变，特异性和敏感性较高。核素骨扫描显示骨的炎性病变极为敏感，但缺乏特异性。B超可显示肋软骨肿胀及结构改建，避免CT因容积效应及体位影响而出现假阳性或假阴性，且容易双侧对比观察肿胀变化。通过详细询问病史，认真查体及辅助检查排除其他疾病后，根据肋软骨炎临床表现和体征确诊。
五、治疗方法
(1)采用非甾体类镇痛消炎药对症治疗。
(2)如疼痛明显、对症治疗欠佳时，可在无菌操作下于肿胀的软骨骨膜注射混有普鲁卡因或利多卡因的长效类固醇激素局部封闭治疗，对减轻肿胀及疼痛疗效确实。
(3)其他治疗：理疗、热敷、抗生素等，但效果欠佳。物理治疗目的是消炎消肿，减轻神经末梢刺激而镇痛，促进血液循环改善局部营养，方法较多，如超声波、低反应水平激光、磁疗法、紫外线照射等。
Benign Posttraumatic Pseudopneumoperitoneum
复制标题
良性创伤后假性气腹
发表时间：2017-12-15
影响指数：2.8
作者： Currin S S
期刊：AJR Am J Roentgenol
Pneumoperitoneum detected in the setting of blunt trauma has classically been thought of as highly suggestive of perforated viscus, requiring urgent laparotomy and surgical repair in the absence of other recognized causes. With the widespread adoption of CT in evaluating trauma patients, identification of small, apparently intraperitoneal, locules of gas is a frequent event; however, many of these patients do not have a perforated viscus. Abdominal ectopic gas is a well-recognized phenomenon in patients with pneumomediastinum and pulmonary interstitial air. The pulmonary interstitial air is able to track centrally along the bronchovascular bundles down a pressure gradient into the mediastinum by a process known as the Macklin effect. The mediastinal gas is then able to migrate caudally along fascial planes via two main pathways: The first pathway is posteriorly through the diaphragmatic hiatuses into the retroperitoneum, and the second pathway is anteriorly from the chest wall into the extraperitoneal space through the Morgagni foramen or along the internal thoracic and superior epigastric vessels. The caudal migration of mediastinal gas through these fascial planes into the extraperitoneal space can resemble pneumoperitoneum. The formation of abdominal ectopic gas via this mechanism has been described in patients on mechanically assisted ventilation, patients who have sustained traumatic alveolar rupture or a tracheobronchial injury, and patients with chest tubes in situ.
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