初诊类风湿关节炎患者肩关节病变高频彩超表现

High-frequency color Doppler ultrasonographic demonstrations of newly-diagnosed rheumatoid arthritis of the shoulder joint

目的观察初诊类风湿性关节炎（rheumatoid arthritis，RA）患者肩关节及其周围软组织病变高频彩超声像表现，探讨超声对RA肩关节病变的辅助诊断价值。方法初诊RA患者40例（80个肩关节），均行高频彩超检查，观察骨侵蚀、肱二头肌长头肌腱（thelonghead of the biceps tendon，LBT）、肩关节滑膜囊、肩袖超声表现。结果骨侵蚀27个肩关节，超声声像表现为骨性轮廓不规则、骨表面连续性差及不规则隆起；15个肩关节滑膜增生，滑膜厚度1．3～5．7（3．10±0．29）mm，增厚的滑膜呈低回声或中等回声，内可见血流信号；11个肩关节有积液，关节腔内见不规则液性区；4个肩关节肩袖损伤（3个位于冈上肌腱，1个位于冈下肌腱）；13个肩关节有LBT病变，腱鞘增宽呈片状低回声，肌腱增粗呈弥漫性的低回声，肌腱厚度（5．2±0．2）mm。结论高频彩超可较准确地检测RA患者肩关节及其周围软组织病变情况，对RA肩关节滑膜病变有一定辅助诊断价值。

Objective To investigate the value of high-frequency color Doppler ultrasonography to diagnosing the shoulder joint diseases by observing the ultrasonographic findings of shoulder joint and peri-artieular soft tissue in patients with newly-diagnosed rheumatoid arthritis （RA）. Methods Forty newly-diagnosed RA patients （80 shoulder joints） were examined by high-frequency color Doppler ultrasonography to observe the ultrasonographie findings of bone erosion, the long head of the biceps tendon （LBT）, shoulder joint synovial bursa and the rotator cuff. Results Bone erosion was found in 27 shoulder joints, and ultrasonography showed irregular bone outline, and poorly continuous and irregular swelling bone surface. Synovial hyperplasia was found in 15 shoulder joints, with the synovial thickness of 1.3 to 5.7 （3.10±0.29） mm, and ultrasonography showed low or medium echo in thickened synovium with blood flow signal. Effusion was found in 11 shoulder joints, with irregular fluid in joint cavity. In 4 shoulders with rotator cuff injury, there were 3 of supraspinatus tendon injury and 1 of subscapular tendon injury. LBT lesions were found in 13 shoulder joints, characterized by slabhy low echo in widened tendon sheath, diffuse low echo in thickened tendon, with the tendon thickness of （5.2±0.2） mm. Conclusion High-frequency color Doppler ultrasonography is valuable in the diagnosis of shoulder RA since it can accurately show the abnormalities of shoulder joint and its peri-articular soft tissues.