中老年大骨节病踝关节影像特征分析

Image features of ankle joint in middle-aged and old patients with Kashin-Beck disease

目的:分析中老年大骨节病踝关节影像特征并测量相关数据,以期为该病的诊治提供量化指标。方法:回顾性分析16例大骨节病32个踝关节的CT表现和4例大骨节病8个踝关节的MRI表现,16例进行CT检查的大骨节病踝患者中,男10例,女6例,平均年龄52.22岁,中位年龄51岁;4例行MRI检查的大骨节病患者均为男性,平均年龄51.33岁,中位年龄52岁;选取16例32个踝关节CT检查正常者作为对照组。用独立样本t检验及方差检验分析32个行CT检查的大骨节病患者及正常对照组踝关节的相关数据(距骨上下径、前后径、左右径,距骨滑车关节面前、中、后宽度,距骨滑车弧形关节面半径,距骨外侧突大小,跟骨前后径、上下径,载距突大小,足舟骨前后径、左右径及上下径,胫骨下端矢状径比距踝关节面3 cm矢状径、胫骨下端冠状径比距踝关节面3 cm冠状径)的差异。结果:(1)与正常对照组的踝关节相比,大骨节病患者的踝关节影像学表现为胫骨下端关节面增粗,距骨变扁,距骨滑车关节面前、中、后宽度增大,滑车弧形关节面半径增大,外侧突增大,跟骨前后径变短、上下径变小,跟骨Gissane’s角变小,足舟骨前后径变小、上下径增大。(2)大骨节病的距骨长度、距骨宽度、载距突大小、足舟骨左右径与正常对照组相比无显著性差异。结论:踝关节影像学表现及其相关数据在大骨节病患者和正常人群中有差异,可作为大骨节病的辅助诊断指标。

Objective:To analyze ankle joint image features of Kashin-Beck disease(KBD)in the elderly and to measure relevant data in order to provide quantitative indicators for the diagnosis and treatment of KBD.Methods:The CT findings of 32 ankle joints in 16 cases of KBD and the MRI findings of 8 ankle joints in 4 cases of KBD were retrospectively analyzed.Among 16 cases of KBD,there were 10 males and 6 females,with an average age of 52.22 years and a median age of 51 years.Four cases of KBD were males,with an average age of 51.33 years and a median age of 52 years.Independent sample t test and variance analysis were used to analyze the difference of ankle CT data between KBD patients and normal controls(talus upper and lower diameter,anterior and posterior diameter,left and right diameter,anterior,middle and posterior width of talus trochlear articular surface,radius of talus trochlear arcuate articular surface,size of lateral process of talus,anterior and posterior diameter of calcaneus,upper and lower diameter of calcaneu,size of sustentaculum tali,anterior and posterior diameter,right and left diameter,upper and lower diameter of scaphoid,sagittal diameter of lower tibia/sagittal diameter of the tibia 3 cm from the ankle articular surface,and coronal diameter of lower tibia/coronal diameter of the tibia 3 cm from the ankle articular surface).Results:(1)Compared with the normal control group,the imaging features of ankle joint in KBD were enlarged articular surface of lower tibia,flattened talus,wider anterior,middle and posterior width of talus trochlear joint,enlarged radius of trochlear arc articular surface,enlarged lateral process,shorter anterior and posterior diameter of calcaneus,smaller Gissane’s angle of calcaneus,smaller anterior and posterior diameter of scaphoid,and larger upper and lower diameter of scaphoid.(2)There was no significant difference in the length and width of talus,the size of sustentaculum tali,the left and right diameter of scaphoid between KBD patients and normal controls.Conclusion:The imaging manifestations of ankle joint and the measurement of related data are different between KBD and normal people,which can be used as an auxiliary diagnostic index of KBD.