骨盆正位像评价强直性脊柱炎髋关节病变临床意义研究  

Pelvic anteroposterior digital radiography in understanding hip joint involvement of ankylosing spondylitis

作　　者：欧阳苏珊[1] 王高亚 李敏[1] 刘旭东[1] 邓涵文 祝紫葳 徐枫[1] 杨娉婷[1] 肖卫国[1] 

机构地区：[1]中国医科大学附属第一医院风湿免疫科,辽宁沈阳110001

出　　处：《中国实用内科杂志》2017年第6期537-539,共3页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81271324)

摘　　要：目的总结强直性脊柱炎(ankylosing spondylitis,AS)患者骨盆正位像中髋关节病变的特点,以及骨盆正位像在评价AS患者髋关节病变中的意义。方法对2010-01-01—2015-12-31期间中国医科大学附属第一医院风湿免疫科门诊就诊或住院的79例AS患者进行骨盆正位像检查,详细分析髋关节病变的特征,比较髋关节有无异常患者的临床特点,并借助统计学方法对数据和研究结果进行分析。结果 48例(60.8%)患者骨盆正位像提示髋关节出现异常改变,其中最具特征的表现为继发于肌腱端炎的慢性改变和髋关节间隙变窄。与髋关节正常组患者比较,异常组患者疾病病程更长[(9.1±6.2)年对(5.5±6.3)年,P=0.02],血清C-反应蛋白(C-reactive protein,CRP)水平更高[(34.8±34.4)mg/L对(19.1±16.5)mg/L,P=0.02];异常组患者中40例患者伴有臀部疼痛,而正常组中仅有13例患者主述臀部疼痛,两组比较差异有统计学意义(40/48对13/31,P<0.01)。另外,64例患者出现典型的骶髂关节的改变,包括局限性或弥漫的骶骨和髂骨硬化、侵蚀;伴或不伴关节间隙的改变、甚至间隙消失。结论骨盆正位像作为最基本的影像学手段,反映了AS患者髋关节病变的特征,对理解AS的髋关节病变具有重要意义。建议将骨盆正位像作为筛查髋关节疾病的常规检查方法。Objective To explore the clinical features of pelvic anteroposterior digital radiography of ankylosing spondylitis （AS） and its significance in the evaluation of hip joint involvement in AS patients. Method Seventy-nine outpatients or hospitalized AS patients diagnosed in the Department of Rheumatology and Immunology, the first Affiliated Hospital of China Medical University, from January 1st, 2010 to December 31th, 2015, undertook pelvic anteroposterior digital radiography. We marie detailed analysis of hip joint involvement and compared the difference in the clinical characteristics between normal and abnormal groups. The data and results were statistically analyzed. Results In this study, there were 48 （60.8%） patients whose radiograph of the pelvis showed abnormalities in the hip joint, among which enthesitis-related chronic changes and joint space narrowing were the most typical characteristics. Compared with patients with normal hip joints （normal group）, the disease course was longer[（9.1±6.2）years vs（ 5.5±6.3 ）years, P=0.02], and the levels of serum C-reactive protein （CRP） increased in patients of abnormal group[（34.8±34.4）mg/L vs （19.1±16.5） mg/L, F=0.02]. The proportion of patients with hip pain was also significantly higher than that of patients in abnormal group（40/48 vs 13/31, P〈0.01）. In addition, there were 64 patients with typical sacroiliac joint changes, including limited or diffused sacral and iliac sclerosis, erosion, with or without joint space changes. These abnormalities all should be taken seriously and given a timely assessment. Conclusion Radiography of the pelvis, the most basic means of imaging methods, can reflect the characteristics of hip joint diseases in patients with AS, and it is of great significance in helping clinicians understand hip joint diseases and optimize clinical management. We recommend that it should be taken as a clinical routine examination to screen the hip joint diseases.

关 键 词：强直性脊柱炎 髋关节 骨盆正位像 

分 类 号：R593.23[医药卫生—内科学]