高频超声评估儿童血友病性骨关节病的初步研究  

Value of high frequency ultrasound in assessment the changes of haemophiliac arthropathy in children

作　　者：张宁宁[1] 吴润晖[2] 彭芸[1] 

机构地区：[1]首都医科大学附属北京儿童医院影像中心,北京100045 [2]首都医科大学附属北京儿童医院血液中心,北京100045

出　　处：《中华超声影像学杂志》2014年第8期701-704,共4页Chinese Journal of Ultrasonography

基　　金：2014年首都卫生发展科研专项“中国儿童重型血友病A个体化预防治疗探索”;国家自然科学基金（81341018）;2013年北京市卫生系统“215”高层次卫生技术人才队伍建设工程学科骨干资助项目;国家自然科学基金面上项目（31271161）

摘　　要：目的 探讨高频超声在评估儿童血友病膝、踝、肘关节病变中的应用价值.方法 对42例临床确诊的血友病病患者的80个关节进行超声检查,其中29例的62个关节同期行X线检查,总结受检关节的超声影像特点,并对比两种检查方法对骨病变检出情况的一致性.结果 42例血友病患者的80个关节中超声显示关节周围软组织肿胀12个,滑膜增厚48个,增厚的滑膜厚度2.01～11.12 mm,平均（4.71±2.26）mm;40个血流信号增强,关节积液53个,含铁血黄素沉积33个,骨破坏36个,关节面下囊肿20个,软骨缺失31个.29例62个行X线检查的关节中,超声显示骨破坏29例,关节面下囊肿16个,软骨缺失24例;X线检查骨破坏23个,关节面下囊肿16个,关节间隙变窄20个.两种检查方法对检出关节骨病变方面显示出较好的一致性,骨破坏、关节面下囊肿、软骨缺失的Kappa值分别为0.803,0.832,0.790,P值分别为0.041,0.026,0.032.结论 高频超声检查对血友病性骨关节病及其周围组织病变的敏感性较高,是血友病性骨关节病患者关节检查的首选和重要方法.Objective To discuss the value of high frequency ultrasound in assessment the changes of knee,ankle and elbow joints with haemophiliac arthropathy in children.Methods Eighty joints of 42 haemophiliac patients were enrolled in this study.Sixty two joints of 29 patients were examined by X-ray at the same time.The correlation of ultrasonography and X-ray on bone aspects were compared.Results Among 80 joints of 42 haemophilic patients,soft tissue swelling was showed in 12 joints,synovial hypertrophy was in 48 joints,the thickness range of synovial membrane was from 2.01 to 11.12 mm [（4.71± 2.26）mm],increased blood flow was in 40 joints,effusion in 53 joints,haemosiderin was in 33 joints,bone erosion was in 36 joints,subchondral cyst formation was in 20 joints,cartilage damage or disappear was in 31 joints.Ultrasonograthy showed bone erosion in 29 joints,subchondral cyst formation was in 16 joints,cartilage damage was in 24 joints.X-ray showed bone erosion in 23 joints,subchondral cyst was in 16 joints,narrowing joint space was in 20 joints.There was high correlation between the osteochondral domain of the ultrasonography and X ray：Kappa value were 0.803,0.832,0.790 respectively（P ＜0.05）.Conclusions Ultrasonography is sensitive to detect the signs of enrolled joints in hemophiliac patients.It is an important method on diagnosis for hemophiliac arthrophv.

关 键 词：超声检查 血友病 骨疾病 关节疾病 

分 类 号：R725.5[医药卫生—儿科] R445.1[医药卫生—临床医学]