类风湿性关节炎患者膝关节软骨病变的超声研究

目的探讨超声检查在类风湿性关节炎（RA）患者膝关节软骨病变诊断中的应用价值。方法选取RA患者43例,按病程分为病程〈5年组（n=19）、病程5～10年组（n=12）和病程〉10年组（n=12）;另取同期该院20名健康自愿者作为对照组。各组分别应用灰阶超声观察膝关节软骨。43例RA患者同时行X线平片检查,其中19例患者另行MRI检查。结果正常对照组股骨关节面软骨厚度内侧髁为（1.8±0.6）mm,外侧髁为（1.9±0.6）mm,正中沟为（2.5±0.7）mm;RA患者组内侧髁〈1.2mm,外侧髁〈1.3mm,正中沟〈1.5mm。病程〈5年组、病程5～10年组及病程〉10年组超声对软骨病变的检出率分别为21.1%、58.3%和91.7%,三组间比较差异有统计学意义（P〈0.01）。43例RA患者（86个膝关节）均行超声和X线检查,超声对软骨检出率为41.9%,X线检出率为0,两种检查方法比较差异有统计学意义（P〈0.01）。19例患者同时行超声与MRI检查,超声对软骨病变的检出率为26.3%,MRI检出率为47.4%,两种检查方法比较差异无统计学意义（P〉0.05）。结论超声能较好地监测RA患者疾病发展过程中膝关节软骨病变,但X线无法辨别软骨病变;超声与MRI在RA患者膝关节软骨病变的诊断中均有良好的应用价值。

Value of ultrasound of articular cartilage of knee in rheumatoid arthritis

Objective To investigate the value of ultrasound in diagnosis of diseases of articular cartilage of knees in patients with rheumatoid arthritis (RA). Methods Forty-three patients with RA were selected, and were divided into disease course＜5 year group （n=19）, disease course 5 to 10 years group （n=12）and disease course＞10 year group （n=12）. Besides, another 20 healthy volunteers were served as control group. Articular cartilages of knees were observed by gray scale ultrasound in each group. Forty-three patients with RA underwent X-ray examinations, among whom 19 also received MRI examinations. Results The thickness of medial condyle of articular cartilage of knees in control group was (1.8±0.6) mm, lateral condyle was (1.9±0.6) mm, median sulcus was (2.5±0.7) mm, and that in patients with RA was ＜1.2 mm, ＜1.3 mm and ＜1.5 mm, respectively. The detection rates of diseases of articular cartilage by ultrasound in disease course ＜5 year group, disease course 5 to 10 years group and disease course ＞10 year group were 21.1%, 58.3% and 91.7%, respectively, and there were significant differences among groups （P<0.01）. For the 43 patients with RA (86 knee articulations) the detection rate of diseases of articular cartilage by ultrasound was 41.9%, that by X-ray examinations was 0, and there were significant differences between these two examinations (P<0.01）. In 19 patients undergoing both ultrasound and MRI examinations, the detection rates of diseases of articular cartilage by ultrasound and MRI were 26.3% and 47.4%, respectively, and there was no significant difference between these two examinations （P＞0.05）. Conclusion The pathological changes of articular cartilage in patients with RA could be better detected by ultrasound than X-ray. Both ultrasound and MRI could be used to detect diseases of articular cartilage of knee in patients with RA.