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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 summarize the characteristics of hip joint disease in patients with ankylosing spondylitis (AS) and to evaluate the significance of pelvis orthostatic imaging in the evaluation of hip joint disease in patients with AS. Methods A total of 79 AS patients treated or hospitalized at the First Affiliated Hospital of China Medical University from January 2010 to January 2015 were enrolled in this study. The pelvic anteroposterior examination was performed to analyze the characteristics of the hip joint in detail. The clinical features of the patients with or without abnormal joints were analyzed and the data and research results were analyzed by means of statistical methods. Results In 48 cases (60.8%), the pelvis orthophoric images showed abnormal changes of the hip joint. Among them, the most characteristic manifestations were chronic changes secondary to tendonitis and narrowing of the hip joint space. Compared with patients with normal hip, the disease duration of patients in abnormal group was longer (9.1 ± 6.2 vs 5.5 ± 6.3 years, P = 0.02), and serum C-reactive protein (CRP) level was more 40 (34.8 ± 34.4) mg / L vs (19.1 ± 16.5) mg / L, P = 0.02). In the abnormal group, 40 patients had hip pain, whereas in the normal group, only 13 patients reported hip pain , The difference between the two groups was statistically significant (40/48 vs 13/31, P <0.01). In addition, 64 patients had typical sacroiliac joint changes, including localized or diffuse sacral and iliac sclerosis, erosion; with or without joint space changes, or even gaps disappearing. Conclusion The pelvic orthopancreatography as the most basic imaging method reflects the characteristics of hip arthroplasty in patients with AS, and is of great significance for understanding the hip joint disease of AS. It is recommended that the pelvis orthographic examination as a common screening method for hip disease.