壤塘县藏区成人大骨节病多个大关节受累与分度的关系研究

目的研究阿坝州壤塘县藏区大骨节病（Kashin-Beck disease,KBD）多个大关节受累与分度之间的相关关系,探索成人大骨节病的合理分级标准,指导临床治疗的可行性。方法由骨科、风湿免疫科和地方病专家联合研究组设计专用调查表,采用现场流行病学调查法,包括一般情况、关节疼痛、视觉模拟疼痛评分（visual analoguescale,VAS）、关节畸形和功能障碍等,随机调查阿坝州壤塘县6个村24～93岁藏族成人大骨节病患者81例,按我国关于成人大骨节病分度标准：Ⅰ度30例,Ⅱ度30例,Ⅲ度21例。大关节定义为肩、肘、腕、髋、膝、踝共12个关节,其中任何一个关节出现疼痛、畸形或功能障碍即为大关节受累。分别统计Ⅰ、Ⅱ、Ⅲ度大骨节病患者大关节受累关节数和VAS评分。结果全部患者均存在2个以上大关节受累,其中肘关节和膝关节受累最多见,9～12个大关节受累在成人大骨节病Ⅱ度患者中比例最高,肘关节和膝关节疼痛VAS评分在成人大骨节病Ⅱ度患者中最高,踝关节受累和疼痛在Ⅲ度成人大骨节病患者中最重,肩、腕、髋关节受累及VAS评分在Ⅰ、Ⅱ、Ⅲ度成人大骨节病患者间无统计学差异,4个以上大关节受累人数在Ⅰ、Ⅱ、Ⅲ度成人大骨节病患者间无统计学差异。结论壤塘县藏区成人大骨节病患者常存在多个大关节受累,大关节受累的比例和程度与目前大骨节病分度之间无统一性;有必要对目前成人大骨节病分度进行合理的修订或改进、完善,使之更符合临床诊治并合理指导成人大骨节病的临床治疗。

Relation between affected big joints and classification of Kashin-Beck disease in adults of Tibetan

Objective To study relation between affected big joints and classification of Kashin-Beck disease （KBD） in adults of Tibetan in Rangtang County Aba Sichuan Province. Methods Totally 81 patients with KBD from 6 villages in Rangtang County Aba Sichuan Province were studied by a union team including orthopaedic surgeons, rheumatoid physicians and endemic disease specialists. All patients with KBD are Tibetans and the age ranged from 24 to 93 years. According to Chinese Adult Classification of KBD, there were 30 cases for grade I , 30 for grade II , and 21 for grade m. A questionaire including patient＇s information, history, visual analogue scale （VAS） for pain, physical examination was used. Big joints were regarded as affected ones if there was pain or deformity or dysfunction for shoulders, elbows, wrists, hips, knees and ankles, totally 12 joints. Results There were 1 - 3 big joints affected for all patients. The joints of elbow and knee were the most easily affected. The percentage of the patients with 9 - 12 affected joints VAS score for elbow and knee were the highest in the patients with grade II. VAS score for ankle was biggest for patients with grade III. There was no difference for the affected shoulders, wrists and hips and VAS scores among patients with grade I , grade II , and grade III, as well as 4 - 8 affected joints. Conclusion Adults KBD patients in Rangtang County Sichuan Province often suffer from multi big joints involvement. There is no consistency between rate and severity of affected big joints and present classification criteria.