女性强直性脊柱炎骶髂关节病变的早期诊断

Early diagnosis of sacroiliac joint lesions in female patients with ankylosing spondylitis

目的:研究女性强直性脊柱炎的骶髂关节病变的早期X线平片、CT影像表现,探讨影像学对强直性脊柱炎的骶髂关节病变诊断价值。方法:对临床确诊的22例强直性脊柱炎的双侧骶髂关节(SIJ)摄X线平片,同时作CT扫描。总结其影像表现及病变分级,作平行对照研究,并进行分析。结果:强直性脊柱炎的骶髂关节病变的患者主诉以髋部疼痛、腰痛、弯腰受限、颈椎受限出现的百分率依次为40.91%、36.36%、18.18%、4.55%。X线骶髂关节影像表现正常、关节变毛糙、模糊、硬化、关节融合分别为13.64%、59.10%、22.73%、4.55%;CT分别为0%、50.0%、45.55%、4.55%。X线与CT诊断的符合率从0级～Ⅳ级分别为0%、66.6%、85.71%、100%。结论:女性强直性脊柱炎的骶髂关节病变的早期诊断受女性自身解剖结构复杂等因素影响,X线平片的早期诊断困难,对临床怀疑而平片难以确诊的早期病变,CT检查有较高价值。平片表现为早期病变(0～Ⅱ级)的患者CT对其分级更为准确,可提高1～2个级别。

Objective： To study the appearances and early fetures of sacroiliac joints （SIJ） female patients with ankylosing spondylitis on X ray film and CT, and to valuate the imaging examination of sacroiliac joints in the early diagnosis. Methods： The plain X-ray film of 22 cases of SIJ of ankylosing spondylitis which had been proved clinically were studied. All the patients had been examed with CT at the same time. The appearances presented by the two methods were concluded compared and graded, the relationship between them was analyzed with statistics. Results： The chief complaint of sacroiliac joint lesions in patients with ankylosing spondylitis are pain of hip, low back pain, limition of lumbar bending,limition of cervical moment, and detection rate of them was 40. 91%, 36.36%, 18.18%, 4.55%. Normal-appearing, coarse of sacroiliac joint, sclerosis of sacroiliac joint, fusion of sacroiliac joint, the detection rate of them by X-ray was 13.64%,59.10%,22.73%,4.55%, and the detection rate of them by CT was 0%, 50.0%, 45.55%, 4. 55%. Coincidence of X-ray and CT from grade 0 to grade Ⅳ was 0%, 66.6%, 85.71%, 100 %. Conclusion： Early diagnosis of sacroiliac joint lesions in female patients with ankylosing spondylitis is influence by complexed anatomic structure of female. X-ray has difficulty in early diagnosis of sacroiliac joint lesions, and CT could prove sacroilitis for those of highly suspected in clinical , which could not be proved by X- ray plain film. To patient X-ray early fetures is 0-Ⅱ grade, its CT grade is more accurate, one to two grade higher than plain film.