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目的:探讨彩色多普勒超声(CDUS)在类风湿性关节炎(RA)腕关节改变的早期诊断的临床应用价值。方法:采用Philips iU Elite彩色多普勒超声诊断仪对45例类风湿性关节炎腕关节改变的患者进行检查,探头L12-5MHz,选用肌肉骨骼条件下CPA和CDFI相结合观察双侧腕关节,详细观察关节周围的积液、滑膜增生、滑膜炎、血管翳、骨侵蚀等,分别记录关节周围积液及增生的滑膜上的血流信号的分布情况。结果:45例类风湿性关节炎腕关节改变的患者关节周围积液均大于正常范围:检出桡腕关节、腕骨间关节、腕掌关节、掌骨间关节积液及滑膜增生,差值1.5~9.8mm,中位数4.2mm,积液最深处约6mm,滑膜最厚处约10.5mm.45例类风湿性腕关节炎患者中25例患者关节内可见滑膜增生并伴有不同程度的关节软骨显示不清,骨皮质连续性中断,15例患者滑膜增生伴有较明显的腕伸肌腱腱鞘炎,仅5例患者表现为关节滑膜层均匀性增厚,无明显积液。结论:CDUS能清晰显示类风湿性关节炎腕关节周围的滑膜炎、骨侵蚀、积液、滑膜增生、血管翳、腱鞘炎等声像图改变,从而为临床诊断早期类风湿性关节炎腕关节改变提供重要依据。
Objective: To investigate the clinical value of color Doppler ultrasound (CDUS) in early diagnosis of wrist joint changes in rheumatoid arthritis (RA). Methods: Forty-five patients with altered rheumatoid arthritis were examined by Philips iU Elite color Doppler sonography. The probe L12-5MHz was selected to observe the bilateral wrist joints by combining the CPA and CDFI under musculoskeletal conditions. Detailed observation of the effusion around the joint, synovial hyperplasia, synovitis, angiostenosis, bone erosion, etc., were recorded around the joint effusion and hyperplasia of synovial blood flow signal distribution. Results: 45 cases of rheumatoid arthritis wrist joint changes in patients with fluid around the joint were greater than the normal range: detection of the wrist radiocarpal joint, carpal joint, metacarpal joint, metacarpal joint effusion and synovial hyperplasia, the difference of 1.5 ~ 9.8mm, the median 4.2mm, the most deep liquid about 6mm, synovial thickest at about 10.5mm. 25 cases of rheumatoid arthritis in 25 patients with synovial hyperplasia of joints and with varying degrees Of articular cartilage showed unclear continuity of cortical bone interrupted, 15 cases of synovial hyperplasia accompanied by more obvious tenosynovitis of wrist extensor tendon, only 5 cases showed synovial homogeneity thickening, no significant effusion. Conclusions: CDUS can clearly show the changes of synovitis, bone erosion, effusion, synovial hyperplasia, vasculitis and tenosynovitis around the wrist joint of rheumatoid arthritis. Therefore, CDUS can be used to diagnose the early stage of rheumatoid arthritis Joint changes provide an important basis.