超声对类风湿性肩关节炎的早期诊断价值

Rheumatoid arthritis involving shoulder joints : Early diagnostic value of ultrasonography

目的探讨超声在类风湿性关节炎(RA)肩关节病变中的早期诊断价值。方法应用高频超声(HFUS)对40例RA患者(RA组)的60侧病变肩关节进行扫查,观察肩关节腔腋囊侧及后隐窝侧、肩峰下滑囊、肱二头肌长头肌腱鞘4个区域内滑膜厚度、积液深度;观察肱骨头(大结节、前内侧及后外侧)骨表面侵蚀及肩袖损伤;利用能量多普勒超声(PDUS)观察病变区域滑膜血流情况,并与20名健康志愿者(对照组)40侧肩关节扫查结果进行对比。结果超声检出RA组5种病变类型:关节积液、滑膜增生、血管过度形成、肩袖撕裂以及骨质侵蚀,检出率分别为42.50%(102/240)、39.58%(95/240)、20.83%(50/240)、31.67%(19/60)和36.11%(65/180);对照组肩关节腔内未见积液,滑膜未见增生,未见血流信号。与对照组比较,RA组滑膜明显增厚(P<0.01)。结论 HFUS和PDUS可检出类风湿性肩关节炎引起的多种病变,有助于早期诊断。

Objective To explore the early diagnostic value of ultrasonography for rheumatoid arthritis （RA） involving shoulder joints. Methods Forty RA patients （RA group） and 20 health subjects （control group） were enrolled. All sub- jects underwent examination of high frequency uhrasound （HFUS）, and the following indicators were observed： The syno- vial thickness and effusion in shoulder joint cavity （axillary fossa and posterior recess）, subacromial-deltoid bursa, and the sheath of long biceps tendon; bone surface erosion in greater tubercle, anteromedial and posterolateral head of humerus; and the injure of rotator cuff. In addition, blood flow signal in the synovial membrane and the lesions were also observed with power Doppler ultrasound （PDUS）. Results In RA group, five types of lesions were found. The specific lesion type and detection rate were as following： Articuli hydrops （42. 50%, 102/240）, synovial proliferation （39.58%, 95/240）, vascular hyperplasia （20.83%, 50/240）, rotator cuff tear （31.67%, 19/60） and bone erosion （36.11%, 65/180）. In con trol group, neither effusion in shoulder cavity nor blood flow signal in synovial membrane was found. The thickness of syn- ovial membrane in RA group significantly increased compared with the control group （P〈0.01）. Conclusion HFUS and PDUS can contribute to early diagnosis of many kinds of lesions in rheumatoid arthritis involving shoulder joints.