高频超声对手骨关节炎患者骨赘评估的临床价值

目的:总结手OA患者双手骨赘的好发部位,分析骨赘严重程度与临床因素的相关性。方法:选取明确诊断的手OA患者104例,根据病程分为3组:<1年组,1~5年组,>5年组。应用高频超声对手OA患者的第一腕掌关节(CMC1)、掌指关节(MCP)、近端指间关节(PIP)、远端指间关节(DIP)进行探查,记录骨赘部位并进行半定量分级(OSGS),同时记录入组者年龄、病程、ESR、CRP,填写视觉模拟评分(VAS)和澳大利亚/加拿大手骨关节炎指数(AUSCAN)疼痛量表,比较不同病程组的各项指标,统计骨赘好发部位及发生率,分析骨赘与临床因素的相关性。采用Wilcoxon秩和检验,Kruskal-Wallis检验,χ^2检验以及Spearman相关性分析进行统计分析。结果:①共检查双手3120个关节,骨赘占33.56%(1047/3120)。不同病程组OSGS和AUSCAN差异有统计学意义(H=13.485,P<0.01;H=51.491,P<0.01),VAS、ESR、CRP差异无统计学意义(H=5.808,P=0.055;H=2.878,P=0.237;H=2.319,P=0.314)。②双手不同关节区中,PIP所占比重最大(46.54%,484/1040),其次为DIP(46.51%,387/832)、CMC1(30.77%,64/208),MCP所占比重最小(10.77%,112/1040),不同关节区骨赘发生率差异有统计学意义(χ^2=384.194,P<0.01)。③双手指间关节区中,骨赘构成比最大的分别是MCP3(46.43%,52/112)、PIP3(30.58%,148/484)和DIP2(31.01%,120/387)。④OSGS与年龄、病程、VAS、AUSCAN评分呈正相关(r=0.370,P<0.01;r=0.382,P<0.01;r=0.215,P=0.029;r=0.390,P<0.01),与ESR、CRP无相关性(r=0.173,P=0.079;r=0.162,P=0.101)。结论:手OA骨赘多见于PIP,其次为DIP,高频超声对骨赘的探查有助于手OA诊断和评估疾病严重程度。

Clinical value of high frequency ultrasounography in the evaluation of osteophytes in patients with hand osteoarthritis

Objective To summarize the common sites of osteophytes in patients with hand osteoarthritis(OA),and analyze the correlation between the severity of osteophytes and clinical factors.Methods One hundred and four patients with hand OA were selected and divided into three groups according to the disease duration:<1 year,1~5 years,>5 years.The first carpometacarpal joint(CMC1),metacarpophalangeal joint(MCP),proximal interphalangeal joint(PIP)and distal interphalangeal joint(DIP)were detected by high fre-quency ultrasound.The location of osteophytes and osteophyte semi-quantitative grading scores(OSGS)were recorded.The patients age,disease duration,erythrocyte sedimentation rate(ESR),C-reactionprotein(CRP),the visual analogy score(VAS)and Australian/Canadian osteoarthrits hand index(AUSCAN)were collected.The indicators of different groups were compared,the incidence and location of osteophytes was calculated,and the correlation between osteophytes and clinical factors was analyzed.Data were analyzed by Wilcoxon rank sum test,Kruskal-Wallis test,χ^2 test,Spearman correlation analysis.Results①Osteophytes accounted for 33.56%(1047/3120)of the 3120 joints in hands.There were statistically significant differences in OSGS and AUSCAN in different groups(H=13.485,P<0.01;H=51.491,P<0.01),while no statistically difference in VAS,ESR and CRP(H=5.808,P=0.055;H=2.878,P=0.237;H=2.319,P=0.314).②In different joint areas of hands,PIP accounted for the largest proportion(46.54%,484/1040),followed by DIP(46.51%,387/832),CMC1(30.77%,64/208),and MCP accounted for the smallest proportion(10.77%,112/1040).There were statistically significant differences in the incidence of osteophytes in different joint areas(χ^2=384.194,P<0.01).③In the interphalangeal joint areas of hands,the largest osteophytes composition ratio was MCP3(46.43%,52/112),PIP3(30.58%,148/484)and DIP2(31.01%,120/387),respectively.④OSGS were positively associated with age,disease course,VAS and AUSCAN(r=0.370,P<0.01;r=0.382,P<0.01;r=0.215,P=0.029;r=0.390;P<0.01),there was no correlation between OSGS and ESR or CRP(r=0.173,P=0.079;r=0.162,P=0.101).Conclusion PIP are the most common sites of osteo-phytes in hand OA,followed by DIP.High frequency ultrasound can help the diagnosis and evaluate the severity of hand OA.