超声引导下经皮穿刺活检在髋关节结核诊断中的应用价值

Application value of ultrasound guided percutaneous biopsy in the diagnosis of hip joint tuberculosis

目的:探讨超声引导下经皮穿刺活检对髋关节结核的诊断价值。方法:收集2012年12月至2022年12月在解放军总医院第八医学中心收治的45例确诊为髋关节结核的患者,分析其髋关节超声检查影像资料及超声引导下髋关节病变穿刺活检结果,总结髋关节结核的超声影像表现特征,分析超声引导下穿刺活检对髋关节结核的确诊率及髋关节结核不同超声表现对穿刺活检确诊率的影响。结果:根据病变的进展程度,髋关节结核超声表现可分为3种类型。Ⅰ型共10例,表现为滑膜增厚或关节腔积液;Ⅱ型共22例,表现为关节面骨质破坏,不光滑;Ⅲ型共13例,表现为关节结构破坏,融合为混杂回声团块。超声引导下穿刺活检取材成功率为97.8%(44/45),穿刺活检的总确诊率为66.7%(30/45)。Ⅰ型、Ⅱ型及Ⅲ型穿刺确诊率分别为30.0%(3/10)、72.7%(16/22)、84.6%(11/13),Ⅰ型穿刺确诊率低于Ⅱ型及Ⅲ型,差异均有统计学意义(χ^(2)=5.203,P=0.049;χ^(2)=7.078,P=0.013)。结论:常规超声检查可以显示髋关节结核的病变程度,超声引导下穿刺活检对髋关节结核的诊断具有重要价值。

Objective:To investigate the application value of ultrasound guided percutaneous biopsy in the diagnosis of hip joint tuberculosis.Methods:Forty-five patients with hip joint tuberculosis admitted to the Eighth Medical Centre of General Hospital of PLA from December 2012 to December 2022,were collected.Their hip ultrasound examination imaging data and ultrasound guided hip biopsy results were analyzed,and the ultrasound imaging characteristics of hip tuberculosis were summarized.The diagnostic rate of ultrasound guided puncture biopsy for hip joint tuberculosis and the impact of different ultrasound manifestations on the diagnostic rate of puncture biopsy for hip joint tuberculosis were analyzed.Results:Depending on the progression of the lesion,ultrasound manifestations of tuberculosis of hip joint can be divided into three categories.There were 10 patients of typeⅠ,characterized by swollen synovial membrane or joint cavity accumulation,22 patients of typeⅡ,characterized by bone destruction on the joint surface and unevenness,and 13 patients of typeⅢ,characterized by joint structure destruction and fusion into mixed echogenic masses.The success rate of ultrasound-guided puncture biopsy was 97.8%(44/45),and the overall diagnostic rate of puncture biopsy was 66.7%(30/45).Diagnostic rates of typeⅠ,typeⅡand typeⅢwere 30.0%(3/10),72.7%(16/22)and 84.6%(11/13),respectively.Diagnostic rate of typeⅠwas significantly lower than those of typeⅡand typeⅢ(χ^(2)=5.203,P=0.049;χ^(2)=7.078,P=0.013).Conclusion:Conventional ultrasound can demonstrate the pathological morphologic change of hip joint tuberculosis and ultrasound guide biopsy has important value in the diagnosis of tuberculosis hip joint.