彩色多普勒超声对膝关节骨性关节炎与类风湿性关节炎的诊断与鉴别
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摘要
目的:探讨彩色多普勒超声(CDFI)在膝关节骨性关节炎(OA)与类风湿性关节炎(RA)病变中的鉴别诊断价值。
方法:通过彩色多普勒超声对OA病例组(41例)与RA病例组(35例)患者的软骨厚度及滑膜厚度进行对比观察,采用SEQUOIA 512型彩色多普勒超声诊断仪,8—14MHz,使用骨骼肌条件。患者取坐位双膝自然弯曲(45°～90°),对膝关节部位做多切面检查,双侧对照,从多角度观察髌上囊液体厚度及透声情况、膝关节有无积液、髌上囊滑膜厚度、关节面平滑程度、股骨软骨厚度及软骨下骨质破坏程度、股骨内髁及外髁软骨厚度、软组织有无病变、有无血管损伤血栓形成、动态观察肌胜韧带、腘窝囊肿、半月板及关节腔内情况,并选取实验室资料C—反应蛋白(CRP)、类风湿因子(RF)、红细胞沉降率(ESR)与RA、OA做出相关分析。
结果:1.35例RA患者70个膝关节中有10个膝关节正常,60个膝关节均发现不同程度的异常改变;41例OA患者82个膝关节中有7个膝关节正常,75个膝关节均发现不同程度的异常改变。RA及OA组髌上囊积液及滑膜增厚明显高于正常人组;两组股骨内髁处软骨厚度较正常组明显变薄,且OA组股骨内髁处骨质破坏明显高于外髁。2.RA组中可见滑膜局限性或弥漫性增厚,30例伴滑膜血管翳形成;关节软骨及软骨下骨关节面轮廓模糊、关节面毛糙不平、皮质缺损;而OA组中可见滑膜轻度增厚,12例患者未见滑膜血管翳形成者;软骨低回声带内回声不均匀,杂乱且变薄,前缘模糊;可见低回声带消失,软骨下骨局部连续性中断;关节腔积液、半月板及韧带改变,在OA组与RA组之间无显著差异。3.彩色多普勒超声可显示腘窝囊肿的形态大小、囊壁及囊腔内的情况。本研究中观察OA组中有38例患者均有腘窝囊肿,RA组中有31例,说明骨性关节炎与类风湿性关节炎均有腘窝囊肿,且所占比例分别为92.7%和88.6%。4.RA组35例膝关节积液程度与炎性指标ESR相关(P＜0.05),与RF滴度无相关。OA组41例,ESR正常,CRP不增高,RF阴性。5.RA及OA组有76例膝关节,X线平片未见异常,超声检查可见关节腔积液,滑膜增厚,软骨增厚,部分关节软骨厚度变薄及软骨下骨质破坏,说明超声改变可发生于X线改变之前。
结论:1.彩色多普勒超声通过观察膝关节关节积液、滑膜、软骨及软骨下骨改变的程度、部位,表明超声对OA及RA的诊断及鉴别有一定价值。2.彩色多普勒超声诊断膝关节OA患者软骨及骨质破坏程度明显高于RA患者,为OA膝关节病变的特异性改变。3.彩色多普勒超声诊断RA患者膝关节滑膜增厚程度高于OA患者,从而说明滑膜病变是诊断RA的依据之一。增厚滑膜血管翳形成也是RA的病理特点之一。4.RA患者膝关节积液发生率较高,其积液量的变化与ESR相关,可作为病情变化的观察指标之一。OA无特异性的实验室检查结果。5.彩色多普勒超声检查膝关节积液是一种简单、无创、快捷的方法,将对早期诊断、疗效观察、定期随访有帮助,并且值得在临床进一步推广。
Objective:Discussion of color Doppler ultrasound in knee osteoarthritis (OA) and rheumatoid arthritis (RA) disease in the differential diagnosis.
Method: Through the high-frequency ultrasound and color Doppler ultrasoundon the OA patient group (41 cases) and the RA patient group (35 cases) in patients with synovial thickness and cartilage thickness compared with observation, Using SEQUOIA 512-mode color Doppler ultrasonic diagnostic apparatus, the probe frequency 8—14 MHz. Patients with a natural bent knees from sitting (45°-90°), makes the multi-section inspection to the knee joint spot, does the two-sided comparison, from the multiple perspectives observation bin on bursa saccus lacrimalis liquid thickness and the sound transparent situation, whether there is the knee joint accumulate the fluid, bin on pouch synovial membrane thickness, the facies articularis smooth degree, thighbone cartilage thickness and under the thighbone cartilage in the ossein destructiveness, the thighbone the condyle and outside condyle cartilage thickness, the soft tissue whether there is pathological change, whether there is the blood vessel damage thrombus forms, the dynamic observation myo- victory ligament, popliteal cyst, the meniscus and the ticulare the situation, And selects the laboratory material C- response protein (CRP), the kind of rheumatism factor (RF), the red blood cell rate of setting (ESR) with RA, OA to make the correlation analysis.
Results:1. 35 cases of RA patients with 70 knee, 10 the normal knee, the knee joint were found 60 different levels of abnormal changes; 41 cases of knee OA in 82 patients with 7 of the normal knee, The remaining 75 were found in varying degrees of knee joint of the abnormal changes. RA and OA group patellar bursal effusion and synovial thickening significantly higher than the normal group; within two femoral condylar cartilage thickness was significantly thinner than normal, and the OA group with femoral condylar bone destruction Department was significantly higher than outside condyle. 2. In RA group obvious synovial membrane limitation or proliferating accumulation, 30 example partner synovial membrane pannus formation; Under the articular cartilage and the cartilage the joint surface outline is fuzzy, facies articularis coarse uneven, cerebral cortex damage; But in OA group obvious synovial membrane mild accumulation, 12 example patients have not seen the synovial membrane pannus to form; The cartilage lingers in the vocal cord the echo to be non-uniform, disorderly, and thins, the predestined affinity is fuzzy; Obviously lingers vocal cord vanishing, under the cartilage the bone partial discontinuity; The ticulare accumulates the fluid, the meniscus and the ligament change, between the OA group and RA group not remarkable difference. 3. In this research observes in the OA group to have 38 example patients to have popliteal cyst, in the RA group has 31 examples, this full showing class osseous arthritis and rheumatism joint inflammatory arthritis has popliteal cyst, and accounts for the proportion respectively is 92. 7% and 88. 6%. 4. The RA group 35 examples, the knee joint accumulates the fluid degree and inflammatory target ESR is related (P<0. 01), but not t0 RF; The OA group 41 examples, ESR is normal, CRP does not advance, RF negative.5. RA and the OA group has 76 example knee joints, X even piece has not seen exceptionally, the supersonic inspection obvious ticulare accumulates the fluid, the synovial membrane accumulation, the cartilage accumulation, partial articular cartilage thickness thins and under the cartilage the ossein destroys, showed the supersonic change may occur before X change.
Conclusion:1. Ultrasound through the observation of knee joint effusion, the degree and positionalchanges in the synopvius, cartilage and subchondral bone, Ultrasound can provide valuableinformation about the diagnosis and differentiation of RA and OA. 2. the ultrasound diagnosis knee joint OA patient cartilage and the ossein destructiveness is higher than the RA patient obviously, is the OA knee joint pathological change' s specificity change.
3. the ultrasound diagnosis RA patient knee joint synovial membrane accumulation is higher than the OA patient, thus the exposition synovial membrane pathological change diagnoses one of RA bases. The accumulation synovial membrane pannus forms is also one of RA pathology character
4. The RA patient knee joint accumulates the fluid formation rate to be high, its product liquid volume' s change and ESR are related, may take one of condition change observation targets; OA non-specificity laboratory check result. 5. Therefore, the ultrasonoscopy inspection knee joint accumulates the fluid is one kind simple, not creates, the quick method, to the early diagnosis, the curative effect observation, the regular revisit will have the help. And is worth in clinical further promoting.
方法:通过彩色多普勒超声对OA病例组(41例)与RA病例组(35例)患者的软骨厚度及滑膜厚度进行对比观察,采用SEQUOIA 512型彩色多普勒超声诊断仪,8—14MHz,使用骨骼肌条件。患者取坐位双膝自然弯曲(45°～90°),对膝关节部位做多切面检查,双侧对照,从多角度观察髌上囊液体厚度及透声情况、膝关节有无积液、髌上囊滑膜厚度、关节面平滑程度、股骨软骨厚度及软骨下骨质破坏程度、股骨内髁及外髁软骨厚度、软组织有无病变、有无血管损伤血栓形成、动态观察肌胜韧带、腘窝囊肿、半月板及关节腔内情况,并选取实验室资料C—反应蛋白(CRP)、类风湿因子(RF)、红细胞沉降率(ESR)与RA、OA做出相关分析。
结果:1.35例RA患者70个膝关节中有10个膝关节正常,60个膝关节均发现不同程度的异常改变;41例OA患者82个膝关节中有7个膝关节正常,75个膝关节均发现不同程度的异常改变。RA及OA组髌上囊积液及滑膜增厚明显高于正常人组;两组股骨内髁处软骨厚度较正常组明显变薄,且OA组股骨内髁处骨质破坏明显高于外髁。2.RA组中可见滑膜局限性或弥漫性增厚,30例伴滑膜血管翳形成;关节软骨及软骨下骨关节面轮廓模糊、关节面毛糙不平、皮质缺损;而OA组中可见滑膜轻度增厚,12例患者未见滑膜血管翳形成者;软骨低回声带内回声不均匀,杂乱且变薄,前缘模糊;可见低回声带消失,软骨下骨局部连续性中断;关节腔积液、半月板及韧带改变,在OA组与RA组之间无显著差异。3.彩色多普勒超声可显示腘窝囊肿的形态大小、囊壁及囊腔内的情况。本研究中观察OA组中有38例患者均有腘窝囊肿,RA组中有31例,说明骨性关节炎与类风湿性关节炎均有腘窝囊肿,且所占比例分别为92.7%和88.6%。4.RA组35例膝关节积液程度与炎性指标ESR相关(P＜0.05),与RF滴度无相关。OA组41例,ESR正常,CRP不增高,RF阴性。5.RA及OA组有76例膝关节,X线平片未见异常,超声检查可见关节腔积液,滑膜增厚,软骨增厚,部分关节软骨厚度变薄及软骨下骨质破坏,说明超声改变可发生于X线改变之前。
结论:1.彩色多普勒超声通过观察膝关节关节积液、滑膜、软骨及软骨下骨改变的程度、部位,表明超声对OA及RA的诊断及鉴别有一定价值。2.彩色多普勒超声诊断膝关节OA患者软骨及骨质破坏程度明显高于RA患者,为OA膝关节病变的特异性改变。3.彩色多普勒超声诊断RA患者膝关节滑膜增厚程度高于OA患者,从而说明滑膜病变是诊断RA的依据之一。增厚滑膜血管翳形成也是RA的病理特点之一。4.RA患者膝关节积液发生率较高,其积液量的变化与ESR相关,可作为病情变化的观察指标之一。OA无特异性的实验室检查结果。5.彩色多普勒超声检查膝关节积液是一种简单、无创、快捷的方法,将对早期诊断、疗效观察、定期随访有帮助,并且值得在临床进一步推广。
Objective:Discussion of color Doppler ultrasound in knee osteoarthritis (OA) and rheumatoid arthritis (RA) disease in the differential diagnosis.
Method: Through the high-frequency ultrasound and color Doppler ultrasoundon the OA patient group (41 cases) and the RA patient group (35 cases) in patients with synovial thickness and cartilage thickness compared with observation, Using SEQUOIA 512-mode color Doppler ultrasonic diagnostic apparatus, the probe frequency 8—14 MHz. Patients with a natural bent knees from sitting (45°-90°), makes the multi-section inspection to the knee joint spot, does the two-sided comparison, from the multiple perspectives observation bin on bursa saccus lacrimalis liquid thickness and the sound transparent situation, whether there is the knee joint accumulate the fluid, bin on pouch synovial membrane thickness, the facies articularis smooth degree, thighbone cartilage thickness and under the thighbone cartilage in the ossein destructiveness, the thighbone the condyle and outside condyle cartilage thickness, the soft tissue whether there is pathological change, whether there is the blood vessel damage thrombus forms, the dynamic observation myo- victory ligament, popliteal cyst, the meniscus and the ticulare the situation, And selects the laboratory material C- response protein (CRP), the kind of rheumatism factor (RF), the red blood cell rate of setting (ESR) with RA, OA to make the correlation analysis.
Results:1. 35 cases of RA patients with 70 knee, 10 the normal knee, the knee joint were found 60 different levels of abnormal changes; 41 cases of knee OA in 82 patients with 7 of the normal knee, The remaining 75 were found in varying degrees of knee joint of the abnormal changes. RA and OA group patellar bursal effusion and synovial thickening significantly higher than the normal group; within two femoral condylar cartilage thickness was significantly thinner than normal, and the OA group with femoral condylar bone destruction Department was significantly higher than outside condyle. 2. In RA group obvious synovial membrane limitation or proliferating accumulation, 30 example partner synovial membrane pannus formation; Under the articular cartilage and the cartilage the joint surface outline is fuzzy, facies articularis coarse uneven, cerebral cortex damage; But in OA group obvious synovial membrane mild accumulation, 12 example patients have not seen the synovial membrane pannus to form; The cartilage lingers in the vocal cord the echo to be non-uniform, disorderly, and thins, the predestined affinity is fuzzy; Obviously lingers vocal cord vanishing, under the cartilage the bone partial discontinuity; The ticulare accumulates the fluid, the meniscus and the ligament change, between the OA group and RA group not remarkable difference. 3. In this research observes in the OA group to have 38 example patients to have popliteal cyst, in the RA group has 31 examples, this full showing class osseous arthritis and rheumatism joint inflammatory arthritis has popliteal cyst, and accounts for the proportion respectively is 92. 7% and 88. 6%. 4. The RA group 35 examples, the knee joint accumulates the fluid degree and inflammatory target ESR is related (P<0. 01), but not t0 RF; The OA group 41 examples, ESR is normal, CRP does not advance, RF negative.5. RA and the OA group has 76 example knee joints, X even piece has not seen exceptionally, the supersonic inspection obvious ticulare accumulates the fluid, the synovial membrane accumulation, the cartilage accumulation, partial articular cartilage thickness thins and under the cartilage the ossein destroys, showed the supersonic change may occur before X change.
Conclusion:1. Ultrasound through the observation of knee joint effusion, the degree and positionalchanges in the synopvius, cartilage and subchondral bone, Ultrasound can provide valuableinformation about the diagnosis and differentiation of RA and OA. 2. the ultrasound diagnosis knee joint OA patient cartilage and the ossein destructiveness is higher than the RA patient obviously, is the OA knee joint pathological change' s specificity change.
3. the ultrasound diagnosis RA patient knee joint synovial membrane accumulation is higher than the OA patient, thus the exposition synovial membrane pathological change diagnoses one of RA bases. The accumulation synovial membrane pannus forms is also one of RA pathology character
4. The RA patient knee joint accumulates the fluid formation rate to be high, its product liquid volume' s change and ESR are related, may take one of condition change observation targets; OA non-specificity laboratory check result. 5. Therefore, the ultrasonoscopy inspection knee joint accumulates the fluid is one kind simple, not creates, the quick method, to the early diagnosis, the curative effect observation, the regular revisit will have the help. And is worth in clinical further promoting.
引文
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