超声对强直性脊柱炎外周附着点病变早期诊断价值.docVIP

超声对强直性脊柱炎外周附着点病变早期诊断价值 　　[摘要] 目的 研究强直性脊柱炎（AS）患者肌腱附着点病变的声像图特点，探讨超声对AS外周关节病变的早期诊断价值。 方法 应用高频超声及能量多普勒检测40例AS患者和20例健康志愿者，双下肢9个附着点（股四头肌肌腱止点、股骨和胫骨内外髁韧带附着点、髌韧带起点和止点、跟腱止点、跖底筋膜），并对肌腱端异常声像指标进行比较。 结果 共纳入40例AS患者，720个附着点中超声发现217处（30.1%）附着点病变，与对照组360个31处（8.6%）存在统计学差异（P=0.000），其中髌腱止点、股四头肌肌腱附着点及跟腱最常受累。在下肢附着点中，骨赘为最常见的病变。病例组有临床表现的肌腱附着点均有超声阳性表现。 结论 高频超声及能量多普勒可敏感地探查出AS患者肌腱附着点的异常，是AS附着点的早期诊断和疗效观察简便易行及安全有效的检查方法。 　　[关键词] 脊柱炎；超声检查；多普勒；能量；附着点炎 　　[中图分类号] R445.1 [文献标识码] A [文章编号] 2095-0616（2016）01-13-03 　　[Abstract] Objective To study the ultrasonographic features of enthesopathy in ankylosing spondylitis. To explore the clinical value of ultrasound in diagnosis of ankylosing spondylitis. Methods Power Doppler high-frequency ultrasound was adopted to detect 9 tendon insertion sites located in double lower limbs in 20 healthy volunteers and 40 patients with ankylosing spondylitis. The tendon thicknesses and abnormal ultrasonic manifestations were compared between the two groups. Results 40 AS patients and 20 healthy controls were enrolled in this study. 217 of the 720 attaching point lesions （33.1%） were detected in AS group and 31 of 720 attaching point lesions （8.6%） were detected in healthy group （P=0.000）. Of the detected attaching point lesions， those at the distal patellar ligament， the quadriceps femoris attachment， and achilles tendon were most involved. Bursitis was the most common lesion of the attachments in lower extremities. Patients with manifestations of enthesitis have positive ultrasonographic findings. Conclusion US can detect enthesopathy sensitively at distal patellar ligament， sternoclavicular joint and symphysis pubis. It is not only simple， but is safe and effective in early diagnosis of enthesitis in AS patients. 　　[Key words] Ankylosing spondylitis； Ultrasonography； Doppler； Power； Enthesitis 　　强直性脊柱炎是一种慢性、系统性、进展的炎性疾病，除特征性侵犯中轴关节外，往往还侵犯外周关节。通常认为外周关节受累呈良性病程，不留后遗症。高分辨超声检查操作简单、费用低廉，不仅能够较好的显示关节及周围软组织的病理改变[1]，还能对骨和软骨表面的细微病变[2-3]，如肌腱厚度改变、肌腱纤维结构紊乱、滑囊炎、骨侵蚀及骨赘等有明确提示，提高病变的诊