上海交通大学学报（医学版）

›› 2009, Vol. 29 ›› Issue (8): 947-.

• 论著（临床研究） • 上一篇    下一篇

下肢肌腱端病超声诊断

王 燕, 李凤华, 赵 莲, 吴蓉卿, 陈 哲, 夏建国, 郭祎芬   

  1. 上海交通大学 医学院仁济医院超声医学科, 上海 200001
  • 出版日期:2009-08-25 发布日期:2009-09-27
  • 作者简介:王燕（1970—）, 女, 主治医师, 硕士；电子信箱: wangyan_100120@126.com。
  • 基金资助:

    上海市重点学科建设项目（S30203）

Ultrasonography of enthesopathy in lower limbs

WANG Yan, LI Feng-hua, ZHAO Lian, WU Rong-qing, CHEN Zhe, XIA Jian-guo, GUO Yi-fen   

  1. Department of Medical Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200001, China
  • Online:2009-08-25 Published:2009-09-27
  • Supported by:

    Shanghai Key Discipline Construction Project, S30203

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摘要：

目的 探讨血清阴性脊柱关节病（SPA）和类风湿关节炎（RA）下肢肌腱端病的声像图特征。 方法 回顾性分析经临床确诊的43例SPA患者（SPA组）双下肢5处肌腱端声像图特征，并与40例RA患者（RA组）和30例健康志愿者（HC组）的检查结果进行比较。发现具有肌腱端增厚、肌腱端深部滑囊积液、肌腱端内钙化灶、肌腱端骨赘形成或骨侵蚀、肌腱端彩色血流信号阳性，即可判定为肌腱端异常。 结果 SPA组、RA组和HC组分别有93%、85%和23%的患者检测到至少一处肌腱端异常，SPA组与RA组肌腱端异常的超声检出率比较，差异无统计学意义（P>0.05），但均高于HC组的检出率（P<0.05）。SPA组滑囊积液累及的肌腱端所占比例少于RA组（8.6％vs 14.0％，P<0.05），且SPA组滑囊积液的程度轻于RA组[（3.92±1.79 ）mm vs（5.97±2.63）mm，P<0.05]；而其他声像图异常所累及的肌腱端所占比例，SPA组与RA组比较差异无统计学意义（P>0.05）。HC组常见的异常是跟腱附着点远段腱内钙化灶以及骨赘形成，肌腱端均未发现血流信号和滑囊积液。 结论 超声检测下肢肌腱端病的敏感性较高，但声像图表现缺乏特异性；肌腱端深部滑囊积液的严重程度可为病因学诊断提供一定的参考价值。

关键词: 血清阴性脊柱关节病, 类风湿关节炎, 肌腱端病, 超声

Abstract:

Objective To explore the ultrasonographic features of enthesopathy in lower limbs in spondyloarthropathy (SPA) and rheumatoid arthritis (RA). Methods The ultrasonographic features of enthesopathy in both lower limbs of  43 patients with SPA (SPA group) were retrospectively analysed, and were compared with those of 40 patients with RA (RA group)  and 30 healthy controls (HC group). The diagnosis of enthesopathy was made based on the abnormal findings such as increased tendon thickness, bursa fluid, intratendinous calcifications, bony spur and bony erosion, and vascularization. Results Abnormal ultrasonographic findings of tendon were observed in 93% of SPA group,85% of RA group and 23% of HC group, respectively. There was no significant difference in the detection rates of enthesopathy by ultrasonography between SPA group and RA group (P>0.05), while both were significantly higher than that of HC group (P<0.05). The number of tendons with bursitis in SPA group was smaller than that in RA group（8.6％ vs 14.0％，P<0.05）, and  bursitis in SPA group was less severe than that in RA group [（3.92±1.79 ）mm vs（5.97±2.63）mm, P<0.05], while there was no significant difference in the number of tendons with the other abnormal ultrasonographic findings between SPA group and RA group（P>0.05）. The major abnormalities in HC group were calcification and bony spur in distal part of achilles tendon insertion, and no bursa fluid or vascularization was found. Conclusion The ultrasonographic features of  enthesopathy is highly sensitive with lower specificity. The severity of bursitis may help to discriminate the disease cause.

Key words: spondyloarthropathy, rheumatoid arthritis, enthesopathy, ultrasonography

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