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目的观察血友病A性膝关节和踝关节病的超声特征及临床意义。方法 2015年1月—2016年6月在浙江中医药大学附属第一医院就诊的28例血友病A患者的55个膝关节和55个踝关节行超声探查并评分,分析血友病A患者关节滑膜增厚超声评分与软骨改变超声评分的相关性,以及膝关节超声评分与踝关节超声评分的相关性。结果全部28例患者均为男性,中位年龄33.4(6~69)岁。膝关节超声评分与踝关节平均超声评分分别为5.16±0.67和3.87±0.57,差异有统计学意义(P<0.01),且膝关节和踝关节骨侵蚀发生率差异存在统计学意义(P<0.05)。轻型与中间型、重型血友病A患者关节超声评分差异存在统计学意义(P<0.01),但中间型和重型血友病A患者关节超声评分差异无统计学意义(P=0.134)。<18岁和≥18岁年龄组关节超声评分别为3.50±1.00、4.87±0.482,差异无统计学意义(P=0.169)。膝关节超声评分与踝关节超声评分有一定正相关性,差异有统计学意义(r=0.479,P<0.01);滑膜厚度超声评分与软骨改变超声评分存在显著正相关性,差异有统计学意义(r=0.728,P<0.01)。结论超声可有效识别血友病A性膝关节和踝关节病病变,是评估血友病A性膝关节和踝关节病简便易行、安全有效、快捷低廉的检测手段,具有较强的临床实用价值。
Objective To observe the echocardiographic features and clinical significance of hemophilia A knee joint and ankle joint disease. METHODS: From January 2015 to June 2016, 55 knees and 55 ankles of 28 hemophilia A patients attending the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine underwent ultrasound and scoring, and analyzed the hemophilia A patients The correlation between synovial thickening ultrasound score and cartilage change ultrasound score, and the correlation between knee joint ultrasound score and ankle ultrasonic score. Results All 28 patients were male, with a median age of 33.4 (range 6 to 69) years. The scores of knee ultrasound and ankle ultrasound were 5.16 ± 0.67 and 3.87 ± 0.57 respectively (P <0.01), and there was significant difference in the incidence of bone erosion between knee and ankle (P <0.05 ). There was significant difference in the ultrasound score of joint between light and intermediate type, severe hemophilia A (P <0.01), but no significant difference was found in the joint ultrasound score of intermediate and severe hemophilia A patients (P = 0.134). The joint ultrasound scores of <18 and ≥ 18 years old group were 3.50 ± 1.00 and 4.8 ± 0.482 respectively, with no significant difference (P = 0.169). There was a positive correlation between knee ultrasound score and ankle ultrasound score (r = 0.479, P <0.01). There was a significant positive correlation between synovial thickness ultrasound and cartilage changes ultrasound score, the difference was statistically significant Significance (r = 0.728, P <0.01). Conclusion Ultrasound can effectively identify the Hemophilia A of knee and ankle disease, which is a simple, safe, effective, quick and inexpensive method for the evaluation of Hemophilia A of knee joint and ankle joint disease. It has strong clinical utility value.