口长屈肌腱病变与类风湿关节炎性平足症的相关性研究

 目的 探讨长屈肌腱(flexor hallucis longus，FHL)病变与类风湿关节炎(rheumatoid arthritis, RA)性平足症之间的相关性。方法 回顾性分析2010年2月至2011年6月因足部疼痛而就诊的47例(94足)RA患者资料。根据超声探查长屈肌腱病变情况，将患者分为3组：肌腱完整组(A组，27足)，肌腱周围炎症组(B组，40足)，肌腱断裂组(C组，27足)。所有患者均摄足部负重侧位X线片，并基于X线片行足内侧纵弓相关参数测量，包括跟骨倾斜角(heel pitch angle, HPA)、距骨第一跖骨角(tarsal and 1st metatarsal angle，TM1)，并结合3组间年龄、病程等进行相关性分析。结果　A组平均年龄(49.9±9.2)岁，病程(4.7±2.6)年，HPA 21.9°±3.3°，TM1 2.5°±2.2°；B组平均年龄(56.2±9.2)岁，病程(16.2±7.4)年，HPA 16.8°±3.5°，TM1 6.5°±3.2°；C组平均年龄(54.7±8.0)岁，病程(20.9±4.4)年， HPA 11.5°±3.6°，TM1 11.2°±4.9°；3组间上述参数比较有差异。测量HPA4°者：A组5/27足，B组30/40足，C组27/27足，3组间比较有差异。结论 FHL病变在RA患者中常见，其严重程度与RA平足呈正相关，且受年龄及病程双重因素影响。

Relations between flexor hallucis longus changes and pes planus in patients with rheumatoid arthritis

Objective To assess the correlation between tenosynovitis or rupture of the flexor hallucis longus (FHL) and pes planus in patients with rheumatoid arthritis(RA). Methods The data of 47 RA patients (97 feet) with painful feet was retrospectively analyzed which was collected From February 2008 to June 2011. In accordance with the results of the FHL changes got by ultrasonography, the patients were divided into 3 groups. Group A consisted of those with normal FHL (27 feet). Group B consisted of those with FHL tenosynovitis (40 feet), and Group C consisted of those with FHL rupture (27 feet). Load bearing lateral radiographs were taken for all the patients. The correlation study was carried out based on the pes planus-related parameters, such as the measurement of heel pitch angle (HPA) and tarsal and 1st metatarsal angle (TM1). Factors like patients' age and course of disease were also taken into the consideration during the study. Results The mean age of those in group A was 49.9±9.2 years vs. 56.2±9.2 years in group B and 54.7±8.0 years in group C. The mean duration was 4.7±2.6 years in Group A vs. 16.2±7.4 years in Group B 5°±3.6° in Group C. The mean TM1 was 2.5°±2.2° in Group A vs. 6.5°±3.2° in Group B and 11.2°±4.9° in Group C. Significant statistics difference were found among the three groups in these parameters. HPA< 20° was found among 6/27 feet in group A, 31/40 in group B and 27/27 in group C. TM1 >4° was found among 5/27 feet in group A, 30/40 in group B and 27/27 in group C. Conclusion FHL changes were common in RA patients and its severity had positive correlation to pes planus. These changes were affected by age and duration, and could be evaluated effectively by ultrasound.