【摘要】：目的 1、探討超聲觀察正常膝關(guān)節(jié)與類風(fēng)濕膝關(guān)節(jié)聲像圖特點(diǎn)。 2、將超聲檢查結(jié)果與磁共振檢查結(jié)果進(jìn)行對(duì)照,探討超聲診斷類風(fēng)濕性膝關(guān)節(jié)炎的價(jià)值。 3、將類風(fēng)濕膝關(guān)節(jié)炎患者的超聲檢查結(jié)果與實(shí)驗(yàn)室檢查相對(duì)照,觀察它們之間的相關(guān)性。 方法 收集2013年1月至8月在我院風(fēng)濕免疫科就診的類風(fēng)濕患者40例,所有患者均符合2009年美國(guó)風(fēng)濕病協(xié)會(huì)及歐洲抗風(fēng)濕病聯(lián)盟最新診斷標(biāo)準(zhǔn),超聲檢查58個(gè)臨床診斷為類風(fēng)濕性病變的膝關(guān)節(jié),患病膝關(guān)節(jié)腫脹,疼痛,嚴(yán)重者活動(dòng)受限。選取其中30個(gè)膝關(guān)節(jié)行磁共振檢查,以磁共振檢查結(jié)果作為金標(biāo)準(zhǔn)。所有患者均進(jìn)行血沉及C-反應(yīng)蛋白檢查。另選30例正常人60個(gè)正常膝關(guān)節(jié)行超聲檢查,做對(duì)照組。均無關(guān)節(jié)腫痛病史,無發(fā)育異常,男5例,女25例,年齡44歲～55歲。 超聲檢查時(shí)患者取坐位或仰臥位,多體位多切面檢查。使用Hitachi HivisionPreirus彩色多普勒超聲診斷儀,探頭頻率為5MHz～13MHz。選用骨骼肌肉條件。觀察內(nèi)容包括髕上囊有無積液、滑膜厚度及其內(nèi)血供、關(guān)節(jié)軟骨,骨皮質(zhì)及關(guān)節(jié)周圍組織等。分析髕上囊積液深度、滑膜厚度分別與血沉、C反應(yīng)蛋白的相關(guān)性。磁共振檢查設(shè)備為德國(guó)西門子3.0T超導(dǎo)磁共振。 結(jié)果 1、正常組膝關(guān)節(jié)超聲表現(xiàn)關(guān)節(jié)及其周圍軟組織結(jié)構(gòu)層次清晰。肌腱呈中等回聲,長(zhǎng)軸紋理清晰,走形規(guī)則,橫斷面呈圓形或類圓形,界清,呈“篩孔狀”。髕上囊呈窄帶狀低回聲,深度小于2mm。股骨下端軟骨呈均勻低回聲,邊界清楚。骨皮質(zhì)連續(xù)光滑,呈強(qiáng)回聲�；こ示�性高回聲,多數(shù)顯示不清。 2、RA組超聲顯示47個(gè)髕上囊積液,積液形態(tài)不規(guī)則。47個(gè)膝關(guān)節(jié)滑膜增生。23個(gè)膝關(guān)節(jié)增生滑膜內(nèi)可探及血流信號(hào)。36個(gè)膝關(guān)節(jié)出現(xiàn)不同程度的關(guān)節(jié)軟骨破壞。19個(gè)膝關(guān)節(jié)出現(xiàn)股骨下端骨皮質(zhì)破壞。24個(gè)膝關(guān)節(jié)可見胭窩囊腫。髕上囊積液深度、滑膜厚度與血沉及C-反應(yīng)蛋白均呈正相關(guān)。超聲顯示正常對(duì)照組和患病組滑膜厚度及髕上囊積液深度存在顯著差異(P＜0.05)。對(duì)于膝關(guān)節(jié)髕上囊積液、滑膜增生、軟骨損傷及胭窩囊腫的檢出,超聲與磁共振檢出率無明顯差異。 結(jié)論 1、高頻超聲可以清晰顯示類風(fēng)濕性關(guān)節(jié)炎膝關(guān)節(jié)病變,包括髕上囊積液,髕上囊內(nèi)滑膜增厚,股骨下端關(guān)節(jié)軟骨變薄,骨皮質(zhì)連續(xù)性中斷,胭窩囊腫形成等。 2、髕上囊積液、滑膜厚度與血沉、C-反應(yīng)蛋白水平均存在正相關(guān),可在一定程度上為診斷類風(fēng)濕提供依據(jù)。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R593.22;R445.1

【共引文獻(xiàn)】

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本文編號(hào)：2320878