痛风性关节炎的X线诊断

X-ray diagnosis of gouty arthritis

目的总结38例痛风性关节炎的X线表现,探讨痛风性关节炎的X线诊断和鉴别诊断,以提高对本病的认识和诊断准确率。方法对38例确诊为痛风性关节炎的X线表现及病理、临床表现、实验室检查并结合文献进行总结分析。结果痛风性关节炎多发生于四肢小关节,尤以第一跖趾关节为最好发。X线表现主要是软组织偏侧性肿胀,可见散在钙化影;骨质侵蚀性破坏呈穿凿状、蜂窝状缺损,边缘锐利、硬化;关节间隙狭窄,关节面不规整,可发生纤维强直,甚至关节畸形,也可发生半脱位或脱位,可伴有骨质增生,邻近骨质疏松。结论痛风性关节炎的X线表现呈多样化,易与其他单发或多发骨关节病混淆,必须认真分析其X线征象并结合临床表现及实验室检查才能作出正确诊断。

Objective The X-ray findings of 38 cases with gouty arthritis were summarized. The X-ray diagnosis and differential diagnosis were discussed to improve the understanding and diagnostic accuracy of this disease. Methods Combined with literatures, the X-ray findings, pathological and clinical manifestations, laboratory examinations of 38 cases pathologically proved with gouty arthritis were analyzed. Results The gouty arthritis usually occurred in the small joints of limbs, especially in the first metatarsophalangeal joint. The X-ray findings were dissymmetric swellings of soft tissue, scattered calcified shadow; bony erosion in form of scuttling and honeycomb defect with sharp and hard edge, narrowed joint space and irregular articular surface, emergence of fiber stiffness, even joint malformations and subluxation or dislocation, associated with hyperosteogeny and nearby osteoporosis. Conclusion Diversification was presented in X-ray findings of gouty arthritis, which can be easily confused with other single or multiple bone joint diseases. As a result, accurate diagnosis should be based on careful analysis about X-ray findings combined with clinical manifestations and laboratory examination.