氟骨症肘关节病变的临床特征与相关因素分析  

Clinical characteristics and related factors of elbow joint disease in skeletal fluorosis

作　　者：陈国华[1] 何爱伟 王燕玲[1] 李青林 陈晓燕[1] 费秀兰 Chen Guohua;He Aiwei;Wang Yanling;Li Qinglin;Chen Xiaoyan;Fei Xiulan(Endemic Disease Prevention and Control Institute,Gansu Provincial Center for Disease Control and Prevention,Lanzhou 730000)

机构地区：[1]甘肃省疾病预防控制中心地方病预防控制所,兰州730000

出　　处：《中华风湿病学杂志》2024年第6期392-397,共6页Chinese Journal of Rheumatology

基　　金：甘肃省中医药管理局科研项目(GZKP-2020-27);兰州市人才创新创业项目(2019-RC-24)。

摘　　要：目的探讨地方性氟骨症患者肘关节常见临床表现的分布特征及其与影响因素的相关性。方法将甘肃省饮水型地方性氟中毒病区县高台县、皋兰县的13个病区村作为样本村, 对该村全部常住成年居民开展横断面调查, 调查内容:①人口学信息、家族史、现病史调查;②骨科临床专科查体;③前臂(含肘关节)和小腿(含膝关节)数字X线摄影拍片, 并根据X线表现划分肘关节Kellgkn-Lawrence分级(K-L分级);④身高、体质量检测, 并计算体质指数(BMI);⑤应用Mayo肘关节评分量表评价肘关节功能。根据调查结果描述氟骨症患者肘关节临床症状和体征的分布特征, 以及患者年龄、性别、病程、BMI、K-L分级等肘关节功能影响因素的分布特征及其相关性。计数资料和率的比较采用χ^(2)检验或Fisher精确概率法, 符合正态分布的连续资料的相关性分析用Pearson检验, 非正态分布的计量和计数资料用Spearman检验。有序等级资料的相关性分析用Kendall′s Tau-b检验。结果①在501例氟骨症患者中, 共检出肘关节疼痛患者465例(92.8%)、肘关节有压痛者185例(36.9%)、肘关节肿大者300例(59.9%)、肘关节晨僵者415例(82.8%)、肘管综合征阳性者102例(20.4%)、前臂伸肌腱牵拉试验阳性153例(30.5%)、前臂屈肌腱牵拉试验阳性97例(19.4%);肘关节旋转受限以关节活动范围(ROM)在30°~70°者检出率最高(261例, 52.1%), 肘关节伸屈受限以ROM在50°~90°者检出率最高(274例, 54.7%)。②在501例氟骨症患者中, 共检出肘关节有症状和阳性体征者465例, 其中男性检出率<女性, 差异有统计学意义(χ^(2)=41.19, P<0.001)。年龄以50~65岁者最多(274/501, 58.9%), 体质指数以BMI<18 kg/m2者最多(217/501, 46.7%), K-L关节炎放射学分级以Ⅲ级者最多(256/501, 55.0%), 病程以>30年者最多(217/501, 46.7%)。③氟骨症临床特征、Mayo评分与各影响因素的相关性:疼痛与年龄(r=0.79, P<0.00Objective To explore the distribution characteristics of common clinical manifestations of elbow joint in patients with endemic fluorosis and their correlation with the influencing factors.Methods A cross-sectional survey was conducted on all permanent adult residents in 13 endemic fluorosis villages in Gaotai and Gaolan counties of Gansu province.The survey included:①Demographic information,family history,and current medical history.②Physical examination specifically focued on the orthopedic clinical presentations.③Taking DR films of the forearm(including elbow joint)and calf(including knee joint),and classify the elbow joint to grade K-L based on X-ray manifestations.④Measuring height and weight,and calculating BMI index.⑤Applying the Mayo elbow joint rating scale to evaluate elbow joint function.Based on the survey results,the distribution characteristics of clinical symptoms and signs of elbow joint in patients with skeletal fluorosis,as well as the distribution characteristics and correlation of factors affecting elbow joint function such as age,gender,disease course,BMI,K-L grade,etc were described.The comparison of counting data and rates were analyzed withχ^(2) test or Fisher exact probability test.Pearson′s test was used for correlation analysis of continuous data that conforms to normal distribution,and Spearman test was used for non-normal distribution measurement and counting data.The correlation analysis of ordered hierarchical data was conducted using Kendall′s Tau-b test.Results①Among 501 patients with skeletal fluorosis,a total of 465 cases(92.8%)were diagnosed with elbow joint pain.A total of 185 cases(36.9%)were with elbow joint tenderness,300 cases(59.9%)were with elbow joint enlargement,415 cases(82.8%)were with morning stiffness of the elbow joint,102 cases(20.4%)were with cubital tunnel syndrome,153 cases(30.5%)were with positive forearm extensor tendon traction test,and 97 cases(19.4%)were with positive forearm flexor tendon traction test.The detection rate of elbow joint r

关 键 词：氟骨症 肘关节 临床特征 影响因素 

分 类 号：R599[医药卫生—内科学]