超声对类风湿性关节炎膝关节病变的研究

发布时间：2018-11-09 15:58

【摘要】：目的 1、探讨超声观察正常膝关节与类风湿膝关节声像图特点。 2、将超声检查结果与磁共振检查结果进行对照,探讨超声诊断类风湿性膝关节炎的价值。 3、将类风湿膝关节炎患者的超声检查结果与实验室检查相对照,观察它们之间的相关性。方法收集2013年1月至8月在我院风湿免疫科就诊的类风湿患者40例,所有患者均符合2009年美国风湿病协会及欧洲抗风湿病联盟最新诊断标准,超声检查58个临床诊断为类风湿性病变的膝关节,患病膝关节肿胀,疼痛,严重者活动受限。选取其中30个膝关节行磁共振检查,以磁共振检查结果作为金标准。所有患者均进行血沉及C-反应蛋白检查。另选30例正常人60个正常膝关节行超声检查,做对照组。均无关节肿痛病史,无发育异常,男5例,女25例,年龄44岁～55岁。超声检查时患者取坐位或仰卧位,多体位多切面检查。使用Hitachi HivisionPreirus彩色多普勒超声诊断仪,探头频率为5MHz～13MHz。选用骨骼肌肉条件。观察内容包括髌上囊有无积液、滑膜厚度及其内血供、关节软骨,骨皮质及关节周围组织等。分析髌上囊积液深度、滑膜厚度分别与血沉、C反应蛋白的相关性。磁共振检查设备为德国西门子3.0T超导磁共振。结果 1、正常组膝关节超声表现关节及其周围软组织结构层次清晰。肌腱呈中等回声,长轴纹理清晰,走形规则,横断面呈圆形或类圆形,界清,呈“筛孔状”。髌上囊呈窄带状低回声,深度小于2mm。股骨下端软骨呈均匀低回声,边界清楚。骨皮质连续光滑,呈强回声。滑膜呈线性高回声,多数显示不清。 2、RA组超声显示47个髌上囊积液,积液形态不规则。47个膝关节滑膜增生。23个膝关节增生滑膜内可探及血流信号。36个膝关节出现不同程度的关节软骨破坏。19个膝关节出现股骨下端骨皮质破坏。24个膝关节可见胭窝囊肿。髌上囊积液深度、滑膜厚度与血沉及C-反应蛋白均呈正相关。超声显示正常对照组和患病组滑膜厚度及髌上囊积液深度存在显著差异(P＜0.05)。对于膝关节髌上囊积液、滑膜增生、软骨损伤及胭窝囊肿的检出,超声与磁共振检出率无明显差异。结论 1、高频超声可以清晰显示类风湿性关节炎膝关节病变,包括髌上囊积液,髌上囊内滑膜增厚,股骨下端关节软骨变薄,骨皮质连续性中断,胭窝囊肿形成等。 2、髌上囊积液、滑膜厚度与血沉、C-反应蛋白水平均存在正相关,可在一定程度上为诊断类风湿提供依据。
[Abstract]:Objective 1. To investigate the sonographic features of normal knee joint and rheumatoid knee joint by ultrasonography. 2.Compared with the results of magnetic resonance imaging (MRI), the value of ultrasonography in diagnosis of rheumatoid knee arthritis (RA) was discussed. 3. The results of ultrasonic examination in rheumatoid knee arthritis were compared with those of laboratory examination, and the correlation between them was observed. Methods A total of 40 rheumatoid patients from January to August 2013 in our hospital were collected, all of whom met the latest diagnostic criteria of the 2009 American Rheumatological Association and the European Union against Rheumatology. Ultrasonic examination of 58 clinically diagnosed rheumatoid lesions of the knee joint, knee swelling, pain, severe movement constraints. Thirty of the knee joints were examined with magnetic resonance imaging (MRI), and the results of MRI were used as gold standard. All patients were examined for ESR and C-reactive protein. In addition, 60 normal knee joints of 30 normal subjects were examined by ultrasound and the control group. There was no history of joint swelling and pain, no abnormal development, male 5 cases, female 25 cases, age 44 ~ 55 years old. The supersonic examination takes the sitting position or supine position, the multi-position multi-section examination. Using Hitachi HivisionPreirus color Doppler ultrasound diagnostic instrument, the probe frequency was 5 MHz and 13 MHz. Select skeletal muscle condition. The observation included fluid accumulation in the suprapatellar sac, synovial thickness and its internal blood supply, articular cartilage, bone cortex and periarticular tissue. To analyze the correlation between ESR and C-reactive protein (CRP) and the depth of superpatellar sac effusion and synovial thickness. Magnetic resonance examination equipment for Germany Siemens 3.0T superconducting magnetic resonance. Results 1. In the normal group, the structure of the joint and its surrounding soft tissue was clear. The tendon showed medium echo, clear long axis texture, regular shape, round or round cross section, clear boundary and "sieve hole". The suprapatellar sac was narrow-band hyperechoic, and its depth was less than 2 mm. The cartilage at the lower end of the femur was homogeneous and hyperechoic, and the boundary was clear. The bone cortex is smooth and strong echo. Synovium presented linear hyperechoic, most of the display is not clear. 2Ultrasound in RA group showed 47 suprapatellar sac effusion. Irregular form of effusion. 47 synovial hyperplasia of knee joint. 23 knee joint hyperplasia synovium can detect blood flow signal. 36 knee joint appear different degree of articular cartilage destruction. 19 knee joint appear femur cortical fracture Bad. Cysts of popliteal fossa were seen in 24 knees. The depth of superpatellar sac effusion and synovial thickness were positively correlated with ESR and C-reactive protein. The thickness of synovial membrane and the depth of suprapatellar sac effusion were significantly different between the normal control group and the diseased group (P < 0.05). There was no significant difference between ultrasonography and MRI in the detection of suprapatellar sac effusion synovial hyperplasia cartilage injury and popliteal fossa cyst. Conclusion 1. High frequency ultrasound can clearly display knee joint lesions of rheumatoid arthritis, including suprapatellar sac effusion, thickening of synovial membrane in suprapatellar capsule, thinning of articular cartilage at the lower end of femur, disruption of bone cortex, formation of popliteal fossa cyst and so on. 2, superpatellar sac effusion and synovial thickness were positively correlated with ESR and C-reactive protein level, which could provide evidence for the diagnosis of rheumatoid disease to some extent.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R593.22;R445.1

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