类风湿性关节炎肩关节病变的影像学测量

[目的]调查类风湿性关节炎( rheumatoid arthritis,RA)患者的肩关节功能及影像学改变,了解该类人群中肩关节病变现状,分析肩关节破坏的相关因素,为RA肩部疾病的预防和治疗提供临床依据.[方法]随机选择RA患者,记录发病年龄、病程,采用ASES肩关节评分量表评测肩关节功能;拍摄肩关节正位X线片,进行Larson分期,测量肩关节内侧距离(MD)、肩关节上移指数(UI)、肩关节内移指数(MI)、大结节关节面间距(GA),分析Larson分期与上述数据间的相关性.[结果]2010年3月～2010年11月,60人入选本研究,平均年龄(51.34±14.14)岁,男6人,女54人.ASES评分(72.69±24.76)分;完成116肩摄X线片,无明显骨性破坏的肩关节(Larson 0 ～1期)MD为(7.55±0.55) cm,UI为1.38±0.10,MI为1.04±0.29,GA为(0.60±0.22) cm.Larson 分期与ASES评分呈显著负相关(r=-0.028 3,P=0.001),与反映肩关节内移的MD、MI呈显著负相关(r=-0.177,P=0.029和r=-0.438,P＜0.001);与UI无显著相关性(r=-0.062,P=0.253);与GA呈显著负相关(r=-0.369,P＜0.001).与病程和年龄呈显著正相关(r=0.534和r=0.390,P＜0.001),与患病年龄无显著相关性(r =0.091,P=0.165).[结论]肩关节受累在RA患者中广泛存在,其受累程度随着病程增加而增加,随着破坏程度的加剧肩关节旋转中心发生内移,但是尚不明确旋转中心上移与骨性破坏是否同步发展.

Radiographic findings of the shoulder in patients with rheumatoid arthritis

[Objective]To evaluate the shoulder function and radiographs in patients with rheumatoid arthritis,analyze the risk factors for joint destruction,collect the data of shoulder involvement in these patients,and provide support for clinical practice.[Methods]Patients with rheumatoid arthritis were randomly sampled in outpatient department,shoulder function was evaluated with ASES scale(American Shoulder and Elbow Surgeons Standardized Assessment Form,self-report section),shoulder anteroposterior radiographs were taken and the GH joint destruction was graded with Larson method;Medialisation distance(MD),upward migration index(UI),medial displacement index(MI),greater tuberosity-articular surface distance(GA) were measured on radiographs,and the correlation between Larson grade and the measurements were analyzed.[Results]From Mar 2010 to Nov 2010,116 shoulders in 60 patients with rheumatoid arthritis were adopted in our study.The average age of the patients was(51.34±14.14) years(54 females and 6 males).The average ASES score was(72.69±24.76) points,89.66% of the shoulders were found function impairment.On radiographs,65.52% shoulders had radiographic changes(Larson grade 1~4).In the non-affected joints(Larson grade 0~1),the MD was(7.55±0.55) cm,UI was 1.38±0.10,MI was 1.04±0.29,and GA was(0.60±0.22) cm.ASES score had a negative correlation with the GH joint destruction(r=-0.028 3,P=0.001),both MD and MI had a negative correlation with the GH joint destruction(Larson grade)(r=-0.177,P=0.029 and r=-0.438,P<0.001).GA also had a negative correlation with joint destruction(r=-0.369,P<0.001),but we didn’t find correlation between UI and joint destruction(r=-0.062,P=0.253),both disease duration and age had a positive correlation with joint destruction(r=0.534 and r=0.390,P<0.001),but onset age of the disease had no correlation with joint destruction.[Conclusion]Shoulder involvement are common in rheumatoid arthritis,and the destruction of the GH joint increases with the extending of disease duration.The upward migration may have no parallel progress with bone destruction.