超声诊断类风湿关节炎致指伸肌腱自发性断裂的应用价值

目的探讨超声在类风湿关节炎致手指伸肌腱自发性断裂诊断中的应用价值。方法 12例类风湿性关节炎并手指伸肌腱背伸受限、临床疑诊指伸肌腱断裂患者行超声检查,判断其指伸肌腱是否有断裂及断裂程度,并与手术结果对照。结果疑诊指伸肌腱断裂患者12例41条肌腱均行手术治疗,证实肌腱断裂40条,连续性好1条。其中8例为环、小指断裂累及24条肌腱,4例为中、环、小指断裂累及16条肌腱,肌腱断裂处均位于腕关节处。40条断裂肌腱中33条为完全断裂,7条为部分断裂。超声诊断完全断裂33条,部分断裂仅诊断5条,漏诊2条,另有1条肌腱超声诊断为部分断裂,手术显示肌腱连续性完整。对于肌腱断裂的判断超声检查与手术对照Kappa值为0.78。结论超声对类风湿关节炎致指伸肌腱断裂的诊断与手术结果对照一致性较好,其优势是不但可通过动态观察判断损伤程度及断端位置、距离,而且可提供腕关节受侵犯情况,为临床治疗提供重要依据。

Application Value of Ultrasonography in Diagnosing Spontaneous Rupture of Finger Extensor Tendon Induced By Rheumatoid Arthritis

Objective To investigate the application value of high-frequency ultrasonography in diagnosing spontaneous rupture of finger extensor tendon induced by rheumatoid arthritis(RA). Methods A total of 12 RA patients complicated with limited extensor tendon extension and clinically suspected extensor tendon rupture were examined by high-frequency ultrasonography to judge whether the extensor tendon ruptured and its degree,which was also compared with the results of surgery. Results Totally,41 tendons in 12 patients with suspected extensor tendon rupture were treated surgically,and 40 tendons were confirmed ruptured,and 1 tendon with good continuity. Among them,24 tendons were involved in 8 ruptures of the ring and little finger, 4 ruptures were the middle,ring and little fingers that involved 16 tendons,and the tendon fractures were all located at the wrist joint. Thirty-three of the 40 ruptured tendons were completely ruptured and 7 were partially ruptured. Ultrasound diagnosis of complete rupture in 33 cases,partial rupture involves only 5 cases,missed diagnosis in 2 cases,and 1 tendon ultrasound diagnosis of partial rupture;surgery showed complete tendon continuity. For the judgment of tendon rupture,the Kappa score between ultrasonography and surgery was 0.78. Conclusions Ultrasonography is in good agreement with the results of operation in diagnosing extensor tendon rupture induced by RA,which can not only determine the degree of injury and the location and distance of the broken end through dynamic observation,but also provide the wrist joint invasion condition and provide an important basis for clinical treatment.