Sakroileit – an inflammation sacral a joint. Is followed by lower back pains. Depending on the reason, character and prevalence of inflammatory process allocate several forms of a sakroileit differing on symptoms and a current. The trauma, a long overload of a joint (for example, at pregnancy, carrying weights, sedentary work) congenital malformations (an incomplete dislocation of a coxofemoral joint), tumoral processes, exchange violations, and also various infections, both nonspecific, and specific (syphilis, tuberculosis, a brucellosis) can become the reason of development of a sakroileit. Besides, sakroileit it can be observed at a number of autoimmune diseases. At aseptic sakroileita treatment conservative, at purulent – is more often surgical.
Sakroileit (Latin os sacrum sacrum + a podvzdoshny bone of os ilium) – inflammatory process in the field of a sacral podvzdoshnogo of a joint. Can be an independent disease or a symptom of other diseases of infectious or autoimmune character. Usually sakroileit develops on the one hand. Bilateral sakroileit it can be observed at a brucellosis (more rare – at tuberculosis) and is a constant symptom at Bekhterev's disease. The plan of treatment and the forecast depends on a form and the reasons of development of a sakroileit.
Sacral a joint – an inactive joint by means of which the basin connects to a backbone by means of the auriculate joints located on side surfaces of a sacrum. The joint keeps at the expense of the strongest ligaments of a human body – interosseous sacral and lumbar sheaves, short wide bunches which on the one hand are attached to a sacrum, and with another to a podvzdoshny bugristost.
The sacrum is the department of a backbone second from below (below it there is a tailbone). At children sacral vertebras settle down separately from each other. Then at the age of 18-25 years these vertebras grow together among themselves, forming a uniform massive bone. At congenital anomalies of development (a back of a bifid) the union can be incomplete.
Depending on prevalence of inflammatory process allocate the following types of a sakroileit: sinovit (an inflammation of a sinovialny cover), osteoarthritis (an inflammation of articulate surfaces) and pan-arthritis (an inflammation of all tissues of joint).
Depending on character of an inflammation distinguish:
- nonspecific (purulent) sakroileit;
- specific sakroileit (at syphilis, tuberculosis and a brucellosis);
- aseptic (infectious and allergic) sakroileit, developing at autoimmune diseases;
- sakroileit the noninfectious nature, caused by degenerate and dystrophic processes in a joint (after injuries, at overloads, exchange violations and malformations) or an inflammation of a sacral and lumbar sheaf.
Nonspecific (purulent) sakroileit
The break of the purulent center, osteomyelitis or direct infection of a joint at an open trauma can become the cause of a sakroileit. Purulent sakroileit usually unilateral. The beginning of a sakroileit sharp, is observed a rapid current with a fever, substantial increase of body temperature and sharp pains in the bottom of a stomach and in a back on the party of defeat. The condition of the patient with sakroileity quickly worsens, develops heavy intoxication.
Because of pain the patient with sakroileity adopts the compelled provision, bending legs in coxofemoral and knee joints. At a palpation sharp morbidity in the field of a sacral podvzdoshnogo of a joint comes to light. Pains amplify at extension of a leg on the party of defeat and pressure upon wings of podvzdoshny bones. In blood tests at a purulent sakroileit increase in SOE and expressed is defined.
At poorly expressed local clinical manifestations at early stages sakroileit sometimes take for an acute infectious disease (especially – at children). Diagnosis sakroileit also can be complicated because of not too obvious radiological picture or late emergence of the expressed changes on the roentgenogram. On the roentgenogram at a sakroileita expansion of an articulate crack, and also moderate osteoporosis in the field of articulate departments of a podvzdoshny bone and a sacrum can come to light.
The pus accumulating in a joint cavity can break in the next bodies and fabrics, forming purulent flow. In case flowed it is formed in a basin cavity, at a rectal research elastichesky painful education decides on the site of fluctuation. When forming a zatek in buttock area there is hypostasis and morbidity in a buttock. At penetration of pus into the vertebral channel defeat of spinal covers and a spinal cord is possible.
Treatment of a purulent sakroileit is carried out in the conditions of surgical office. At early stages antibiotics are appointed, dezintoksikatsionny therapy is carried out. Formation of the purulent center at a sakroileita is the indication for a joint resection.
Sakroileit at tuberculosis
Sakroileit at tuberculosis it is observed rather seldom, as a rule, proceeds or chronically. The infection usually extends from primary center which is either in a sacrum, or in the field of the articulate surfaces of a podvzdoshny bone. Defeat can be both unilateral, and bilateral.
Patients with sakroileity show complaints to pains of not clear localization in the field of a basin, and also on the course of a sciatic nerve. At children the reflected a knee and coxofemoral joint pains are possible. Constraint as patients sakroileity try to spare the struck area at the movements is observed. In some cases secondary deformations in the form of scoliosis and reduction of a lumbar lordoz are possible. At a palpation moderate morbidity comes to light. Local temperature is increased at a tubercular sakroileit. After a while there is an infiltration of soft fabrics over the inflammation center.
In ¾ cases tubercular sakroileit is complicated by formation of sinter abscesses in a hip. At the same time nearly a half of natechnik is followed by formation of fistulas. On the roentgenogram at a sakroileita the expressed destruction in a podvzdoshny bone or a sacrum is defined. Sequesters can occupy a third and more affected bone. Contours of a joint are washed away, edges are corroded. Partial or total disappearance of an articulate crack is in certain cases observed.
Treatment of a sakroileit is carried out in the conditions of tubercular office. The immobilization is carried out, specific conservative therapy is appointed. In some cases a tubercular sakroileit surgery – a resection sacral joints is shown.
Sakroileit at syphilis
At secondary syphilis sakroileit develops seldom and usually proceeds in the form of the artralgiya which is quickly passing under the influence of specific antibiotic treatment. At tertiary syphilis gummozny can be observed sakroileit in the form of a sinovit or osteoarthritis. Unsharp pains (mainly night) and some constraint are noted because the patient spares the struck area.
At a change sinovita on the roentgenogram do not come to light. At osteoarthritis the radiological picture can differ considerably – from minor changes before partial or final fracture of articulate surfaces. Treatment of a sakroileit specific, in the conditions of skin and venereologic office. It should be noted that now tertiary syphilis meets very seldom therefore such sakroileit widespread belong to the category few.
Sakroileit at a brucellosis
Usually damage of joints at a brucellosis has passing character and proceeds in the form of flying artralgiya. However the resistant, long, difficult giving in to treatment inflammation in the form of a sinovit, reparaarthritis, arthritis or osteoarthritis is in certain cases observed. At the same time sakroileit it is observed rather often (42% of total number of damages of joints).
Sakroileit at a brucellosis can be both unilateral, and bilateral. The patient with sakroileity shows complaints to morbidity in the sacral podvzdoshnoy of area amplifying at the movements, especially – at extension and bending of a backbone. The rigidnost and constraint is noted. The positive symptom of Lasega (a tension symptom) – emergence or strengthening of pain on the back surface of a hip at the moment when the patient raises the straightened leg comes to light. On the roentgenogram at a brutsellezny sakroileit of changes is not present even in the presence of the expressed clinical symptomatology.
Treatment of a sakroileit usually conservative. Specific therapy with use of several antibiotics is carried out, vaccinotherapy in combination with anti-inflammatory and symptomatic means is appointed. At a subsharp and chronic sakroileit the physical therapy and sanatorium treatment is shown.
Aseptic sakroileit can be observed at many rheumatic diseases, including – at psoriatichesky arthritis and a disease of Reuters. Bilateral sakroileit has special diagnostic value at Bekhterev's disease as radiological changes in both sacral joints in this case come to light at initial stages – even before formation of unions between vertebras. The radiological picture, characteristic of a sakroileit, in such cases provides early diagnosis and allows to begin treatment during the period most favorable for this purpose.
At the first stage of a sakroileit on the roentgenogram the moderate subkhondralny sclerosis and expansion of an articulate crack is defined. Contours of joints indistinct. At the second stage of a sakroileit the subchondrosis becomes expressed, the articulate crack is narrowed, single erosion are defined. On the third it is formed partial, and on the fourth – a full anchylosis sacral joints.
Clinical manifestations of a sakroileit soft. Sakroileit at Bekhterev's disease is followed by the mild or moderate pain in buttocks giving to a hip. Pains amplify at rest and weaken at the movements. Patients note the morning constraint disappearing after physical activity.
At identification of changes, characteristic of a sakroleit, in x-ray pictures the additional examination including special functional tests, a X-ray analysis of a backbone and laboratory researches is conducted. At confirmation of the diagnosis sakroileit complex therapy is appointed: nonsteroid anti-inflammatory medicines, physiotherapy exercises, physical therapy, sanatorium treatment.
Sakroileit the noninfectious nature
Strictly speaking, noninfectious defeats sacral joints are not sakroileity as such cases are observed or artrozny changes sacral a joint, or an inflammation sacral sheaves. However in clinical practice in similar cases the diagnosis "is quite often exposed sakroileit not clear etiology".
Such pathological changes can be caused by the previous injuries, a constant overload of a joint owing to pregnancy, sports activities, carrying weights or sedentary work. The risk of development of this pathology increases at violation of a bearing (increase in an angle of lumbar and sacral transition), a wedge-shaped disk between a sacrum and the fifth lumbar vertebra, and also at a nezarashcheniye of an arch of the fifth lumbar vertebra.
Patients show complaints to the pristupoobrazny or spontaneous pain in the field of a sacrum which is usually amplifying at the movements, long standing, sitting or inclinations of a kpereda. Irradiation in a waist, a hip or a buttock is possible. At survey weak or moderate morbidity in the field of defeat and some constraint comes to light. In some cases duck gait (shaking develops here and there when walking). Patognomonichny is Fergason's symptom: the patient gets up on a chair at first a healthy, and then sore leg then descends from a chair, lowering at first healthy, and then a sore leg. At the same time there is pain in the field of a sacral podvzdoshnogo of a joint.
At arthrosis on the roentgenogram narrowing of an articulate crack, an osteosclerosis and deformation of a joint is observed. At an inflammation of a linking of change are absent. Treatment is directed to elimination of an inflammation and pains. NPVP and physiotherapeutic procedures are appointed, at the expressed pain syndrome blockade are carried out. Recommend to limit to the patient physical activity. Carrying special bandages for unloading of lumbar and sacral department is shown to the pregnant women suffering sakroileity.