超声对强直性脊柱炎外周附着点病变的早期诊断价值(1)
[摘要] 目的 研究强直性脊柱炎(AS)患者肌腱附着点病变的声像图特点，探讨超声对AS外周关节病变的早期诊断价值。 方法 应用高频超声及能量多普勒检测40例AS患者和20例健康志愿者，双下肢9个附着点(股四头肌肌腱止点、股骨和胫骨内外髁韧带附着点、髌韧带起点和止点、跟腱止点、跖底筋膜)，并对肌腱端异常声像指标进行比较。 结果 共纳入40例AS患者，720个附着点中超声发现217处(30.1%)附着点病变，与对照组360个31处(8.6%)存在统计学差异(P=0.000)，其中髌腱止点、股四头肌肌腱附着点及跟腱最常受累。在下肢附着点中，骨赘为最常见的病变。病例组有临床表现的肌腱附着点均有超声阳性表现。 结论 高频超声及能量多普勒可敏感地探查出AS患者肌腱附着点的异常，是AS附着点的早期诊断和疗效观察简便易行及安全有效的检查方法。
[关键词] 脊柱炎；超声检查；多普勒；能量；附着点炎
[中图分类号] R445.1 [文献标识码] A [文章编号] 2095-0616(2016)01-13-03
, http://www.100md.com
[Abstract] Objective To study the ultrasonographic features of enthesopathy in ankylosing spondylitis. To explore the clinical value of ultrasound in diagnosis of ankylosing spondylitis. Methods Power Doppler high-frequency ultrasound was adopted to detect 9 tendon insertion sites located in double lower limbs in 20 healthy volunteers and 40 patients with ankylosing spondylitis. The tendon thicknesses and abnormal ultrasonic manifestations were compared between the two groups. Results 40 AS patients and 20 healthy controls were enrolled in this study. 217 of the 720 attaching point lesions (33.1%) were detected in AS group and 31 of 720 attaching point lesions (8.6%) were detected in healthy group (P=0.000). Of the detected attaching point lesions， those at the distal patellar ligament， the quadriceps femoris attachment， and achilles tendon were most involved. Bursitis was the most common lesion of the attachments in lower extremities. Patients with manifestations of enthesitis have positive ultrasonographic findings. Conclusion US can detect enthesopathy sensitively at distal patellar ligament， sternoclavicular joint and symphysis pubis. It is not only simple， but is safe and effective in early diagnosis of enthesitis in AS patients.
, http://www.100md.com
[Key words] Ankylosing spondylitis； Ultrasonography； Doppler； Power； Enthesitis
强直性脊柱炎是一种慢性、系统性、进展的炎性疾病，除特征性侵犯中轴关节外，往往还侵犯外周关节。通常认为外周关节受累呈良性病程，不留后遗症。高分辨超声检查操作简单、费用低廉，不仅能够较好的显示关节及周围软组织的病理改变[1]，还能对骨和软骨表面的细微病变[2-3]，如肌腱厚度改变、肌腱纤维结构紊乱、滑囊炎、骨侵蚀及骨赘等有明确提示，提高病变的诊断率[4-5]。本研究通过二维及能量多普勒超声观察AS患者和志愿者外周附着点的声像和血流情况，检测其在诊断附着点中的临床意义，并观察外周关节损害情况。
1 资料与方法
1.1 一般资料
病例组40例，均为2012年10月～ 2013年4 月到我科就诊AS患者，诊断均符合1984年纽约修订标准[6]，均为男性，年龄16～55岁，平均(29±12)岁。健康对照组：男性志愿者20名，年龄20～55岁，平均(31±10)岁，均无局部感染、关节手术及外伤史、探查部位近3个月行局部激素或其他药物注射治疗。
, http://www.100md.com
1.2 仪器与方法
采用意大利百盛MyLab 30GOLD超声诊断仪，选用7～15，12～18MHz线阵探头。由有经验的经过肌肉骨骼超声正规培训的风湿科医生进行超声检查，检查部位参照临床常见的外周附着点炎部位和格拉斯哥超声附着点评分(GUESS)[7]系统设定，包括跖底筋膜、跟腱止点、股四头肌肌腱止点、股骨和胫骨内外髁肌腱附着点、髌韧带起点和止点。检查股四头肌肌腱止点、股骨和胫骨内外髁肌腱附着点、髌韧带起点和止点，要求患者仰卧位或坐位，膝关节屈曲30°、下肢伸展；检查跖底筋膜及跟腱，要求俯卧位，双足屈曲90°悬空置床边缘。对股四头肌肌腱止点、髌韧带起点和止点、跟腱止点、跖底筋膜采用格拉斯哥超声附着点评分(GUESS)进行判读，股骨和胫骨内外髁韧带附着点主要记录附着部位骨侵蚀、骨赘、韧带厚度改变、韧带内钙化情况。每个部位分别行纵向及横向扫查[8]。然后采用能量多普勒超声观察所有受检附着点处血流分布情况。, 百拇医药(崔若玫 李锦春 赵悦吟 徐健)
[关键词] 脊柱炎；超声检查；多普勒；能量；附着点炎
[中图分类号] R445.1 [文献标识码] A [文章编号] 2095-0616(2016)01-13-03
, http://www.100md.com
[Abstract] Objective To study the ultrasonographic features of enthesopathy in ankylosing spondylitis. To explore the clinical value of ultrasound in diagnosis of ankylosing spondylitis. Methods Power Doppler high-frequency ultrasound was adopted to detect 9 tendon insertion sites located in double lower limbs in 20 healthy volunteers and 40 patients with ankylosing spondylitis. The tendon thicknesses and abnormal ultrasonic manifestations were compared between the two groups. Results 40 AS patients and 20 healthy controls were enrolled in this study. 217 of the 720 attaching point lesions (33.1%) were detected in AS group and 31 of 720 attaching point lesions (8.6%) were detected in healthy group (P=0.000). Of the detected attaching point lesions， those at the distal patellar ligament， the quadriceps femoris attachment， and achilles tendon were most involved. Bursitis was the most common lesion of the attachments in lower extremities. Patients with manifestations of enthesitis have positive ultrasonographic findings. Conclusion US can detect enthesopathy sensitively at distal patellar ligament， sternoclavicular joint and symphysis pubis. It is not only simple， but is safe and effective in early diagnosis of enthesitis in AS patients.
, http://www.100md.com
[Key words] Ankylosing spondylitis； Ultrasonography； Doppler； Power； Enthesitis
强直性脊柱炎是一种慢性、系统性、进展的炎性疾病，除特征性侵犯中轴关节外，往往还侵犯外周关节。通常认为外周关节受累呈良性病程，不留后遗症。高分辨超声检查操作简单、费用低廉，不仅能够较好的显示关节及周围软组织的病理改变[1]，还能对骨和软骨表面的细微病变[2-3]，如肌腱厚度改变、肌腱纤维结构紊乱、滑囊炎、骨侵蚀及骨赘等有明确提示，提高病变的诊断率[4-5]。本研究通过二维及能量多普勒超声观察AS患者和志愿者外周附着点的声像和血流情况，检测其在诊断附着点中的临床意义，并观察外周关节损害情况。
1 资料与方法
1.1 一般资料
病例组40例，均为2012年10月～ 2013年4 月到我科就诊AS患者，诊断均符合1984年纽约修订标准[6]，均为男性，年龄16～55岁，平均(29±12)岁。健康对照组：男性志愿者20名，年龄20～55岁，平均(31±10)岁，均无局部感染、关节手术及外伤史、探查部位近3个月行局部激素或其他药物注射治疗。
, http://www.100md.com
1.2 仪器与方法
采用意大利百盛MyLab 30GOLD超声诊断仪，选用7～15，12～18MHz线阵探头。由有经验的经过肌肉骨骼超声正规培训的风湿科医生进行超声检查，检查部位参照临床常见的外周附着点炎部位和格拉斯哥超声附着点评分(GUESS)[7]系统设定，包括跖底筋膜、跟腱止点、股四头肌肌腱止点、股骨和胫骨内外髁肌腱附着点、髌韧带起点和止点。检查股四头肌肌腱止点、股骨和胫骨内外髁肌腱附着点、髌韧带起点和止点，要求患者仰卧位或坐位，膝关节屈曲30°、下肢伸展；检查跖底筋膜及跟腱，要求俯卧位，双足屈曲90°悬空置床边缘。对股四头肌肌腱止点、髌韧带起点和止点、跟腱止点、跖底筋膜采用格拉斯哥超声附着点评分(GUESS)进行判读，股骨和胫骨内外髁韧带附着点主要记录附着部位骨侵蚀、骨赘、韧带厚度改变、韧带内钙化情况。每个部位分别行纵向及横向扫查[8]。然后采用能量多普勒超声观察所有受检附着点处血流分布情况。, 百拇医药(崔若玫 李锦春 赵悦吟 徐健)