能量多普勒超声对类风湿性胫后肌腱损伤早期诊断价值

Rheumatoid arthritis involving tibialis posterior tendon：study on the early diagnostic value of power Doppler ultrasonography and comparison with surgery

目的探讨能量多普勒超声（PDUS）对类风湿性（RA）胫后肌腱损伤的早期诊断价值。方法2014年1月至2015年12月光华医院足踝外科就诊患者，以RA腱病组（48例60足）为研究对象，非RA腱病组（12例20足）和健康志愿者组（10例20足）作为对照。应用PDUS观察胫后肌腱血管翳血流信号情况，判断肌腱有无损伤及损伤程度。采用X2检验对比和分析：（1）血流信号阳性率；（2）血流信号等级检测情况；（3）血流信号分布区域：弥漫性或局限性。结果研究入选患者70例100足，血流信号阳性检出仅在RA组（88．3％）和非RA组（40．0％）。其中Ⅲ级血流信号RA组检出20．0％，非RA组未检出；Ⅱ级RA组36．7％，非RA组10．0％，检出率及等级比较差异均有统计学意义（均P〈0．01）。血流信号分布区域不同，前者肌腱全程均可探及，后者分布于舟骨结节附近。研究对3例PDUS显示Ⅲ级的患者行外科手术，发现血管翳形成与超声表现一致。结论PDUS可观察肌腱滑膜炎时新生血管形成情况，在RA累及足部尚未出现足部畸形之前发现早期肌腱损伤，指导临床早期干预治疗，防止畸形等严重后果发生。

Objective To explore the value of power Doppler ultrasonography （PDUS） in the early diagnosis of tibialis posterior tendon injury induced by rheumatoid arthritis （RA）. Method From January 2014 to December 2015, a total of 48 cases （60 feet） of RA tendinopathy group were selected as the research subjects from Guanghua Hospital; 12 cases（20 feet） of non-RA tendinopathy group and 10 cases （20 feet） of healthy volunteers were selected as control group. The blood flow signals of pannus were observed by PDUS to determine whether the tendon was injured or the degree of the injury. The following indexes were compared and analyzed by Chi-square testing： （ 1 ） positive rate of blood flow signal; （ 2 ） grade of blood flow signal ; （ 3 ） spatial distribution of blood flow signal ： diffusibility or local. Results Of 70 eases （ 100 feet） in the study,the positive blood flow signals were only in the RA （88.3%） and non-RA group （40. 0% ） . Grade Ⅲ in RA was 20.0% ,while this was not observed in non-RA. Grade Ⅱ in RA and non-RA was 36. 7% and 10. 0% , respectively. There were significant differences in the positive rate and grades between RA and non-RA group （ P 〈 0. 01 ）. The spatial distribution of blood flow signal in RA was significantly different from that in non-RA. In RA, they can be detected in the whole tendon. However, they were mainly distributed around the seaphoid in non-RA. In this study, three patients with grade Ⅲ were treated with surgery. The intraoperative findings were consistent with the preoperative ultrasound results. Conclusions PDUS can be used to detect the neovascular formation of tendon synovitis. It can detect the early tendon injury before the appearance of foot deformity induced by RA, which can guide clinical early intervention treatment and prevent the occurrence of deformity and other serious consequences.