吉林省饮水含氟量不同地区居民前臂和小腿骨关节X线改变

X-rays changes of forearm and shank of residents from areas with different fluoride contents in drinkingwater in Jilin province

目的了解饮水含氟量不同地区居民前臂和小腿常见x线征象，为诊断氟骨症提供依据。方法应用定量流行病学方法，在吉林省乾安和农安县选择建屯时间在50年以上，居民饮用水含氟量历史资料完整且氟含量稳定、没工业和燃煤氟污染、无其他高氟来源及未改饮低氟水的15个村屯作为调查点。测定水氟，再按饮水含氟量（0．5～7．0m∥L）的11个层次选取居住10年以上且年龄在16～60周岁的居民。按年龄16～、21-、31～、4l～、51—60周岁分成5个年龄组，每个年龄组采用分层抽样的方法，抽取10～15例做前臂和小腿骨关节X线检查。将饮水含氟量在0．5一1．0mg／L作为低氟组（对照），在1．5—7．0mg／L作为高氟组，分别观察两组居民各种X线征象及检出率。结果X线检查结果显示，可见到氟骨症、关节退变和骨质疏松3种改变。其中关节退行性改变最常见，高氟组的检出率（31．55％，153／485）高于低氟组（21．58％，41／190），二者比较差异有统计学意义 （X2=6．62，P〈0．05）；在x线检查的675例中，检出氟骨症72例，主要发生在摄氟较多的高氟组（x。=25．65，P〈0．01）。当水氟达6．O～7．0mg／L时，氟骨症检出率显著增加达44．92％（53／118）。不论水氟高与低或氟骨症病情轻与重，X线征象均以骨周改变为主，平均达到了95．83％（69／72），关节改变次之（79．17％，57／72），骨质改变最少（56．94％，4l／72），三者比较差异有统计学意义（x2=9．64，P〈0．01）。不论水氟高与低，肘、膝、腕关节都有退变改变，退变总检出率以肘关节最高（17．78％，120／675），膝关节次之（15．4l％，104／675），腕关节检出率最低（7．85％，53／675），三者比较差异有统计学意义（x2=30．74，P〈O．01）。高氟组肘关节退变检出率（21．03％，102／485）明显高于低氟组（9．47％，18／190，）（。=12．47，P〈0．01）。X线检查可见35种征象，多数征象在高氟、低氟组均可见到，其中骨周改变低氟组少见，多出现在高氟组。结论氟骨症骨关节X线征象复杂多样，进行X线诊断时应对各种征象进行全面分析，通过综合判定，诊断结果才能准确、可靠。

Objective To understand common X-ray signs of bone and joint of forearm and shank, in order to provide a basis for diagnosis of skeletal fluorosis. Methods A total of 15 villages which were built for more than 50 years in Nongan and Qianan counties of Jilin province were selected and surveyed by quantitative epidemiological methods. These villages had no industrial and coal-burning-borne fluorine pollution; no other high fluoride sources; had not yet changed to low-fluoride drinking water, and had complete and stable historic data of fluoride content in drinking water. Drinking water fluoride content was determined. Inhabitants lived in the local for more than 10 years, between the age of 16 - 60 were chosen from the villages based on the 11 levels of fluoride content of drinking water from 0.5 - 7.0 mg/L and these people were divided into 5 age groups ： 16 -, 21 -, 31 -, 41 -, 51 to 60. In each age group, 10 - 15 individuals were taken by stratified random sampling to do the forearm and shank joint X-ray examination. Drinking water fluoride content between 0.5 - 1.0 mg/L acted as the low fluoride group（control group）, 1.5 - 7.0 mg/L as the high fluoride group and various X-ray findings and the detectionrate were observed. Results Three X-ray signs of skeletal fluorosis, joint degenerative change and osteoporosis were observed. Thereinto, joint degenerative change was the most common. In the high fluoride group（31.55%, 153/485）, the detection rate of joint degenerative change was higher than that of the low fluoride group（21.58%, 41/190） and the difference was statistically significant（x2 = 6.62, P 〈 0.05）. Seventy two of 675 peoples used by X-ray were detected with skeletal fluorosis, which occurred mainly in the higher intake of high fluoride group （X2 = 25.65, P 〈 0.01）. When water fluoride was up to 6.0 - 7.0 mg/L, the detection rate of endemic skeletal fluorosis was increased to 44.92% （53/118）. Regardless of higher or lower of water fluoride and mild or more serious of the state of fluorosis, changes of X-ray signs of bone surroundings happened first; on average with a detection rate of 95.83% （69/72）, the joint change followed by 79.17% （$7/72） and bone substance change the least at 56.94%（41/72）, and the difference was statistically significant（~2 = 9.64,P 〈 0.01）. Regardless of water fluoride high and low, joint of elbow knee and wrist underwent degenerative change. Degenerative change of elbow joint happened first with a detection rate of 17.78%（120/675）, knee joint followed by 15.41% （104/675）, and wrist joint was the least at 7.85% （53/675）. The difference was statistically significant（x2 = 30.74, P 〈 0.01）. Elbow degeneration detection rate（21.03%, 102/485） in high fluoride group was significandy higher than that of the low fluoride group（9.47%, 18/190; X2= 12.47, P 〈 0.01）. X-ray examination showed 35 kinds of signs; most signs could be seen in the high fluoride and the low fluoride groups. But the changes of bone around were seen more often in higher fluoride content group thanin lower fluoride content group. Conclusions X-ray signs of endemic skeletal fluorosis are complex and diverse. Only after comprehensive analysis, the diagnostic results are accurate and reliable.