成人骨关节炎手骨X线片解读及其流行病学应用

Reading a radiograph on right hand to diagnosis of adult osteoarthritis in epidemiologic studies

目的 构建一种解读右手 X线片诊断成人骨关节炎 (OA)的新方法用于流行病学研究。方法 1拍照 45岁以上人口右手 X线片 335张 ;2依次读片发现骨棘、关节腔狭窄、软骨下硬化、囊性变、侧位变形、骨皮质塌陷等病理影像 ;3根据所见给每一个案打分 :0分表示无所见 ,1分表示有病理变化存在但尚未涉及骨关节变形 ,2分表示出现不同程度的骨关节变形 ;4观察的范围不包括拇指、小指 ,而涉及其余的 6个指关节、3个掌指关节和腕关节 ;将每张手片各部位分数叠加成单一数表示病情的严重程度。结果 1提供了一个判别力好的新方法 ,按个例计算打分全距最小为 0最大为 2 4;2用此方法分析 335例 X线片 ,OA阳性率为 73.8% ,其中轻症者为 45 .7% ,较重症者为 2 8.6 % ,与文献报告结果相近 ;3此方法对于判别地区间差异效果良好。结论 方法比较简捷 ,对个案、群体均有较强判别力 ,适合在流行病学研究中应用。

Objective To build up a new method for diagnosis of osteoarthritis with X ray photograph on man's right hand in adults aged over 45 years.Methods ①Take X ray photograph on people aged over 45 years in a number of 335 cases.②Read pictures one by one to find out pathologic changes of osteophyte,joint space narrowing,sub chondral sclerosis,cyst,deformity and collapse of joint cortical bone.③According to the seriousness give a score to each case:score 0 means no changes are found out,score I means some changes are found out but no deformities are formed in that joint,and score Ⅱ means some deformities are observed.④Except of the big and little fingers,all of 6 joints of interphalanngeal,3 joints of metacarpophalangeal and joint of wrist are included in the scope for observation,and scores recorded in a hand are added up to a simple figure for expression of the sickness state of OA in that case.Results ①The method presented in this paper is a good tool for discrimination of sickness state of OA between individual adults,in normal one the score is zero and in a serious one it is 24.②Using the method to observe on a population consisted of 335 cases,the prevalence rate of OA in total is 73.8%,in which the mild and sever case of OA are 45.7% and 28.6% respectively,these figures are consistence well with data published in literatures.③The differences of prevalence of OA between some locals are detected easily by this method,if it is in existing practically.Conclusions The method presented in this paper for diagnosis of OA in epidemiologic studies is a new consideration and is an effective tool.