银屑病性关节炎外周关节的超声和X线检查比较

Comparison of ultrasonography and X-ray in the assessment of peripheral joints invovement in psoriatic arthritis

目的对比超声和X线检查在银屑病性关节炎外周关节病变诊断中的作用。方法对25例银屑病性关节炎患者的125组关节分别行超声和X线检查，对二者结果进行分析、比较。结果25例患者的病变累及部位包括：膝关节9例，腕关节9例，踝关节9例，掌指／指间关节10例，跖趾／趾间关节11例，超声对以上关节病变的检出率高于X线（P〈0．01）。超声影像的主要表现为滑膜炎（29例）、肌腱炎（16例）、骨质侵蚀（7例）。X线影像的主要表现为骨质破坏（11例）、骨质疏松（5例）、骨膜反应（3例）和软组织肿胀（4例）等。超声对滑膜、肌腱病变等银屑病性关节炎外周关节早期改变的检出率高于X线检查（P〈0．01），X线对银屑病性关节炎外周关节骨质病变的检出率高于超声检查（P〈0．01）。结论超声能够发现银屑病性关节炎外周关节早期病变。超声与X线检查相结合，可使诊断更为准确、全面。

Objective To compare and investigate the role of ultrasonography and X-ray examination in the assesment of peripheral joints in psoriatic arthritis （PsA）. Methods One hundred and twenty-five groups joints of twenty-five patients with PsA underwent ultrasonography and X-ray examination,including knee joints, wrist joints, ankle joints, metacarpophalangeal joints and interphalangeal finger joints, metatarsophalangeal joints and interphalangeal toe joints. The results of the two examinations were analysed and compared. Results The numbers of patients with abnormal joints in knee joints, wrist joints, ankle joints, metacarpophalangeal/interphalangeal finger joints, and metatarsophalangeal/interphalangeal toe joints were 9,9,9,1 0, and 11, respectively. Ultrasonography found more abnormal joints than X-ray （ P d0. 01 ）. The cardinal ultrasonographic manifestations of PsA were synovitis （29）, tendonitis （16） ,and bone erosion （7）. The cardinal X-ray manifestations of PsA were bone destruction （11）, periarticular osteoporosis （5）, periosteal reaction （3） and periarticular soft tissue swelling （4）. Ultrasonography found more synovium and tendon abnormalities than X-ray （P 〈0.01）, and X-ray found more bone abnormalities than ultrasonography （ P 〈0.01）. Conclusions Ultrasonography has the ability of demonstrating early changes of peripheral joints in PsA. The combination of ultrasonography and X-ray can make the diagnosis of PsA more correct and comprehensive.