壤塘县成人大骨节病患者上肢功能障碍原因分析

The Main Reasons Resulting in Functional Impairment of Upper Limbs in the Adults with Kashin - Bek Syndrome in Rangtang County

目的：研究壤塘县成人大骨节病患者上肢关节损害流行病学特征与功能障碍的关系，为制定综合防治措施提供依据。方法：采用骨科、风湿免疫科和地方病专家联合研究组设计的专用调查表，包括一般情况、临床症状、视觉模拟疼痛评分（VAS）和体征，对阿坝州壤塘县藏族成人大骨节病患者201例上肢功能障碍的主要因素进行分析。结果：201例中，有171例（85％）存在肘关节疼痛，VAS8．6分；156例（78％）腕关节疼痛，VAS7．4分；135例（67％）指间关节疼痛，VAS5．2分；39例（19％）肩关节疼痛，VAS4．9分。上肢功能障碍最严重是伸肘，其次是伸腕和屈肘，再其次是屈腕。60％患者出现握拳、做饭和穿衣等日常生活能力受限，50％存在洗漱和进餐受限。23％不能完成洗漱和穿衣，15％不能完成做饭、进餐和握拳。结论：壤塘藏族成人大骨节病患者肘腕关节疼痛和活动受限影响上肢功能，导致其日常生活能力下降。

Objective ：To investigate the relationship between the epidemiologic features of adult Kashin-Bek syndrome in Rangtang County and the patients＇ upper limb disorders, in order to preferably prevent and treatment this syndrome. Methods ：201 patients with Kashin-Bek syndrome from 6 villages in Aba Rangtang County of Siehuan province were studied by a union team including orthopaedic surgeons, rheumatologists and experts at endemic diseases. All the patients are Tibetans, whose mean age was 56.3 years old （ from 27 to 90 years）, including 89 males and 112 females. The questionnaire was designed and requested the patients writing their related information including general state of health, clinical symptom, visual analogue scale （VAS） for pain and physical signs. Results ： There were 171 cases complaining elbow pain, the score of VAS was 8.6; 156 wrist pain, VAS 7.4; 135 interphalangeal joints pain, VAS 5.2 ; 39 shoulder pains, VAS 4.9. The most severe functional impairment of upper limbs was elbow joint extension, the followings were wrist extension and elbow flexion, next was wrist flexion. Over 60% of the adults with Kashin-Bek syndrome in Rangtang County had a limited activity of daily living, such as clench fist, cooking, putting on clothes and et al. The abilities of face-wash and eating were limited in approximately 50% of these patients, face-wash and dressing in 23% , cooking, eating and clenching fist in 15%. Conclusions：The limitation of motion and pain of elbow and wrist joints were the main reasons impacting the upper extremity function of the adults with Kashin-Bek syndrome in Rangtang County, whichresulted in the decreased activity of daily living.