中国膝骨关节炎患者超声表现

Ultrasonographic features of knee osteoarthritis in Chinese population

目的了解中国膝OA患者的超声表现。方法入选2013年2月至2014年8月北京大学第一医院风湿免疫科674例膝OA患者，对双膝关节超声结果进行回顾性分析，了解其超声下的表现。超声评价指标包括骨赘的数量及位置、滑膜炎及软骨厚度等，采用t检验χ^2检验进行分析。结果674例膝OA患者中绝大多数（96．1％）存在骨赘，并且多为双膝骨赘。股骨骨赘发生率最高（85．2％），其次为胫骨、髌骨。骨赘数量从0～10个不等，男女性骨赘数量差异无统计学意义，但60岁以上患者的骨赘明显多于60岁以下患者，半数以上患者双膝骨赘对称。滑膜囊病变方面：髌上囊病变发生率最高[积液279例（41．4％），滑膜增生189例（28．0％），滑膜炎24例（3．6％）]。双膝股骨髁表面软骨厚度均为[（2．1±0．6）mm]，差异无统计学意义。但女性软骨厚度显著低于男性[左膝：（2．0±0．5）mm和（2．5±0．8）mm，t=3．859，P〈0．05；右膝：（2．0±0．5）mm和（2．5±0．8）mm，t=4．109，P〈0．05]，60岁以上较60岁及以下患者软骨更薄[左膝：（2．0±0．6）mm和（2．2±0．6）mm，t=2．108，P〈0．05；右膝：（2．0±0．6）mm和（2.2±0．6）mm，t=2．507，P〈0．05]。所有患者未发现焦磷酸钙沉积。结论膝OA患者的超声下表现中，骨赘为最常见表现，股骨骨赘的发生率最高，双膝骨赘分布基本对称，60岁以上患者骨赘数量更多。近半数患者存在关节腔积液，1／3患者存在滑膜增生或滑膜炎，此外，双膝软骨退变也基本对称，女性及60岁以上患者软骨更薄。

Objective To investigate the musculoskeletal ultrasound （MSUS） findings in Chinese knee osteoarthritis （OA） patients. Methods All the MSUS data were from the outpatients with knee OA who visited Department of Rheumatology and Clinical Immunology, Peking University First Hospital from February 2013 to August 2014. MSUS findings included number and position of osteophyte, synovitis, thickness of cartilage, and so on. Comparisons between groups were made using t test, Chi-square tests. Results Six hundreds and seventy-four patients were included. Almost all the patients （96.1%） had osteophytes, most patients had both knees osteophytes. The most common osteophyte location was femoral （85.2%）, followed by tibia and the upper edge of patella. The number of osteophytes differed from none to ten, and the distribution of bilateral knee osteophytes was symmetrical in most patients. There was no significant difference in the number of osteophytes between male and female, and patients over 60 years old had more osteophytes than the patients aged 60 or below. In all bursae lesions, the suprapatellar bursa were the most commonly affected [effusion, 279 （41.4%）, synovial hyperplasia, 189（28.0%）, synovitis 24 （3.6%）]. There was no significant difference in the cartilage thickness between .bilateral knees. But the cartilage thickness of female patients was significantly thinner than that of men [left： （2.0±0.5） mm vs （2.5±0.8） mm, t=3.859, P〈0.05; right： （2.0±0.5） mm vs （2.5±0.8） mm, t=4.109, P〈0.05], and the patients over 60 years old had thinner cartilage than patients younger than 60 years old [left： （2.0±0.6） mm vs （2.2±0.6） mm, t=2.108, P〈0.05; right： （2.0±0.6） mm vs （2.2±0.6） mm, t=2.507, P〈 0.05]. None patient had Calcium pyrophosphate dehydrate （CPPD） deposition in the cartilage. Conclusion In the uhrasonographic findings of knee OA in China, osteophyte could be found in 96% patients, the most common location of osteophyte is the femur area. The distribution of bilateral knee osteophytes is symmetrical in most patients. Patients over 60 years old have more osteophytes. Nearly half patients have joint effusion, one third patients have synovial hyperplasia or synovitis. Bilateral knee cartilage degeneration is symmetrical. Women and patients over 60 years old have thinner cartilage.