膝骨性关节炎的中医证型与超声声像图的相关性研究  

Study on Correlation of Traditional Chinese Medicine Syndrome Types with Ultrasonogram of Knee Osteoarthritis

作　　者：万蓉[1] 钟娜[2] WAN Rong;ZHONG Na(The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Guangdong Second Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510095 Guangdong,China)

机构地区：[1]广州中医药大学第一附属医院,广东广州510405 [2]广东省第二中医院,广东广州510095

出　　处：《广州中医药大学学报》2020年第4期622-626,共5页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省自然科学基金项目(编号:S2011010004410)。

摘　　要：【目的】通过高频彩色多普勒超声的微观影像特点,探讨膝骨性关节炎(KOA)中医辨证分型与超声声像图改变的关系,为临床诊断及治疗提供依据。【方法】选择符合纳入标准的60例KOA患者(共79个患膝)为研究对象,观察不同证型患者患膝的关节软骨、滑膜囊等组织的病变特点,探讨KOA患者中医证型与超声声像图表现的关系。【结果】(1)对KOA患者的79个患膝进行中医分型,其中筋脉瘀滞型26膝(占32.91%),湿注骨节型23膝(占29.11%),肝肾亏虚型30膝(占37.98%)。(2)不同证型KOA患者的患膝均有髌上囊积液、滑膜增厚、软骨回声改变等特点。其中筋脉瘀滞型的滑膜病变较轻;湿注骨节型的积液量明显增多,滑膜血流丰富;肝肾亏虚型的软骨退变明显,变薄或缺失,软骨下骨面不平整。不同证型间比较:湿注骨节型的髌上囊积液深度和容量均较肝肾亏虚型和筋脉瘀滞型明显增多(P<0.05),滑膜血流显示率均较肝肾亏虚型和筋脉瘀滞型明显升高(P<0.05);且肝肾亏虚型的髌上囊积液深度和容量均较筋脉瘀滞型明显增多(P<0.05),软骨厚度均较筋脉瘀滞型明显变薄(P<0.05)。【结论】KOA的中医辨证分型与关节软骨退变程度、髌上囊积液量、滑膜厚度及血供有相关性;膝关节超声检查声像图可作为中医辨证分型的参考指标,可为临床辨证治疗KOA提供可视的、无创的、动态客观的疗效评价依据。Objective To explore the relationship between traditional Chinese medicine(TCM)syndrome differentiation and ultrasonographic changes of knee osteoarthritis(KOA)through analyzing the characteristics of high frequency color Doppler ultrasonography(HFCDUS),so as to provide evidence for the clinical diagnosis and treatment of KOA.Methods Sixty cases of KOA patients with 79 affected knee joints were selected as the studying subjects according to the inclusion criteria.The pathological characteristics of cartilage and synovial sac of knee joints of the KOA patients with various syndrome types were observed.The correlation of TCM syndrome types of KOA patients with the ultrasound images was explored.Results(1)The 79 affected knee joints were differentiated into the syndrome type of stasis obstruction of tendon and meridian(26 knee joints,32.91%),downward attack of dampness in the joints(23 knee joints,29.11%),and insufficiency of liver and kidney(30 knee joints,37.98%).(2)All KOA patients had the characteristics of suprapatellar bursa effusion,synovial membrane thickening and cartilage echo changes.Mild changes in synovial membrane were shown in the KOA patients with the syndrome type of stasis obstruction of tendon and meridian,increased amount of suprapatellar bursa effusion with rich blood flow in the synovial membrane was shown in the type of downward attack of dampness in the joints,and obvious cartilage degeneration with thin or lost cartilage,and uneven subchondral bone surface were shown in the type of insufficiency of liver and kidney.The comparison among the 3 syndrome types showed that the type of downward attack of dampness in the joints had larger depth and volume of suprapatellar bursa effusion and higher positive echo rate of blood flow in the synovial membrane than the type of insufficiency of liver and kidney and the type of stasis obstruction of tendon and meridian(P<0.05),and the type of insufficiency of liver and kidney had larger depth and volume of suprapatellar bursa effusion and thinner cartilage

关 键 词：膝骨性关节炎 彩色多普勒超声检查 中医证型 

分 类 号：R274.9[医药卫生—中西医结合] R684.3[医药卫生—中医骨伤科学]