MSUS和X线检查对类风湿性关节炎膝关节病变的临床诊断价值

Clinical diagnostic value of MSUS and X-ray examination in knee joint lesions of rheumatoid arthritis

目的 探讨肌骨超声(MSUS)和X线检查对类风湿性关节炎(RA)膝关节病变的临床诊断价值,以指导RA的诊断和治疗。方法 选取2020年11月至2023年11月安徽医科大学第一附属医院收治的49例RA患者,所有患者均接受双侧膝关节的MSUS和X线检查。通过回顾性分析,比较MSUS和X线在膝关节病变声像特征方面的差异。结果 MSUS检查对滑膜炎、关节腔/髌上囊积液、骨侵蚀、半月板损伤、腘窝囊肿的检出率高于X线检查,差异具有统计学意义(P<0.05);MSUS检查对骨赘/骨质增生、骨质疏松、周围软组织肿胀的检出率低于X线检查,差异具有统计学意义(P<0.05);MSUS和X线检查对关节间隙狭窄的检出率无明显差异(P>0.05)。结论 MSUS和X线检查在RA膝关节病变的诊断中各有优势。MSUS对软组织结构病变更敏感,而X线在骨性结构改变的检测上更为准确。两种检查方法在声像特征上互补,结合使用可以为RA的诊疗提供更全面、可靠的影像学依据。建议在临床实践中综合运用这两种检查手段,以获得更精确的诊断和更有效的治疗策略,通过这种多模态影像诊断方法,医生可以更好地评估RA患者的病情,制定个性化的治疗计划。

Objective To explore the clinical diagnostic value of musculoskeletal ultrasound(MSUS)and X-ray examination in knee joint lesions of rheumatoid arthritis(RA),so as to guide the diagnosis and treatment of RA.Methods Forty-nine patients with RA admitted in the First Affiliated Hospital of Anhui Medical University from November 2020 to November 2023 were selected.All patients underwent MSUS and X-ray examinations of bilateral knee joints.Through retrospective analysis,the differences between MSUS and X-ray in the sonographic features of knee joint lesions were compared.Results The detection rates of synovitis,joint cavity/suprapatellar bursa effusion,bone erosion,meniscus injury and popliteal cyst by MSUS examination were higher than those by X-ray examination,and the differences were statistically significant(P<0.05);the detection rates of osteophyte/bone hyperplasia,osteoporosis and surrounding soft tissue swelling by MSUS examination were lower than those by X-ray examination,and the differences were statistically significant(P<0.05);there was no significant difference in the detection rate of joint space stenosis between MSUS and X-ray examination(P>0.05).Conclusion MSUS and X-ray examination have their own advantages in the diagnosis of knee joint lesions of RA.MSUS is more sensitive to soft tissue structure lesions,and X-ray is more accurate in the detection of bone structure changes.The two methods complement each other in terms of sonographic features,and the combination of them can provide a more comprehensive and reliable imaging basis for the diagnosis and treatment of RA.It is recommended to use these two methods in clinical practice to obtain more accurate diagnosis and more effective treatment strategies. Through this multimodal imaging diagnostic method, doctors can better evaluate the condition of RA patients and develop personalized treatment plans.