AS髖關節(jié)受累影像學表現(xiàn)與臨床特點相關性探討
發(fā)布時間：2018-09-19 08:16
【摘要】：目的:通過對AS患者一般情況、臨床表現(xiàn)、實驗室檢查、影像學檢查、診治情況等結(jié)果對比,探討不同影像學檢查在診斷AS患者髖關節(jié)受累中的價值及影像學表現(xiàn)與臨床特點之間相關性。方法:收集患者一般信息、臨床表現(xiàn)、實驗室檢查、影像學檢查(骨盆X線平片、髖關節(jié)CT及MRI)、診治情況等資料,應用獨立樣本T檢驗及Χ2檢驗對結(jié)果進行分析。結(jié)果:117例AS患者234側(cè)髖關節(jié)中,X線平片顯示異常為46側(cè),MRI顯示異常為151側(cè);X線平片顯示異常包括:間隙狹窄:34側(cè),股骨頭密度不均:15側(cè),骨質(zhì)破壞:20側(cè),骨質(zhì)硬化:10側(cè),骨質(zhì)增生:8側(cè);MRI顯示異常包括:關節(jié)積液:110側(cè),滑膜增厚:12側(cè),滑膜強化:21側(cè),骨髓水腫:79側(cè),肌腱端炎:1側(cè),骨質(zhì)破壞:15側(cè),間隙變窄:10側(cè),脂肪沉積:4側(cè)。行CT檢查的88例共176側(cè)髖關節(jié)中,異常關節(jié)數(shù)為60側(cè),其中35側(cè)骨破壞未能在X線平片中顯示,43側(cè)骨破壞未能在MRI中顯示。X線平片、CT、MRI顯示髖關節(jié)異常分別為18.8%(33/176)、34.1%(60/176)和63.6%(112/176),在影像學顯示髖關節(jié)受累的敏感度方面,MRI優(yōu)于X線平片和CT(X2值分別為73.19和30.74,P值均0.05)。有髖關節(jié)影像學慢性骨結(jié)構(gòu)改變的患者較無慢性骨結(jié)構(gòu)改變的患者發(fā)病年齡小、病程短、病史中有更多髖關節(jié)疼痛或活動受限、BASFI高(P均0.05)。相對于病史中無髖關節(jié)疼痛或活動受限的患者,病史中有髖關節(jié)疼痛或活動受限的患者以頸部為首發(fā)癥狀的患者少、出現(xiàn)髖關節(jié)影像學慢性骨結(jié)構(gòu)改變較多(P均0.05),既往接受正規(guī)專科治療較多(P0.05),余(P均0.05)差別無統(tǒng)計學意義。結(jié)論:在診斷AS髖關節(jié)受累的影像學檢查中,骨盆X線平片只能發(fā)現(xiàn)中、晚期病變,可用于疾病篩查;X線平片、CT和MRI均能顯示AS髖關節(jié)受累的慢性骨結(jié)構(gòu)改變,但在顯示髖關節(jié)間隙狹窄方面X線平片敏感度最優(yōu),在顯示微小骨質(zhì)破壞方面,CT敏感度最優(yōu);X線平片和CT不能顯示MRI能顯示的急性炎性期改變。發(fā)病年齡小、病程短、BASFI高、病史中有髖部疼痛或活動受限的AS患者更易出現(xiàn)髖關節(jié)影像學慢性骨結(jié)構(gòu)改變;以膝關節(jié)炎為首發(fā)癥狀的AS患者病程中不易發(fā)生髖關節(jié)慢性骨結(jié)構(gòu)改變。以頸部疼痛或活動受限為首發(fā)癥狀的患者病史中出現(xiàn)髖部疼痛或活動受限較少,有髖關節(jié)疼痛或者活動受限的患者更易出現(xiàn)髖關節(jié)影像學慢性骨結(jié)構(gòu)破壞,更易就診及接受正規(guī)專科治療。
[Abstract]:Objective: to compare the general situation, clinical manifestation, laboratory examination, imaging examination, diagnosis and treatment of AS patients. To explore the value of different imaging examination in the diagnosis of hip involvement in patients with AS and the correlation between imaging findings and clinical features. Methods: the data of general information, clinical manifestation, laboratory examination, imaging examination (pelvis plain film, CT and MRI), diagnosis and treatment of hip joint) were collected, and the results were analyzed by independent sample T test and X 2 test. Results among the 234 cases of AS, 46 sides were abnormal in MRI, 34 sides in narrow space, 15 sides in uneven density of femoral head, 20 sides in bone destruction, 10 sides in bone sclerosis, 10 sides of bone sclerosis, 34 sides of narrow gap, 15 sides of uneven density of femoral head, 20 sides of bone destruction, 10 sides of bone sclerosis. The MRI findings of 8 sides of osteomatous hyperplasia included: synovial thickening: 1 / 110, synovial thickening: 12, synovial enhancement: 21, bone marrow edema: 1: 79, tendonitis: 1, bone destruction: 15, gap narrowing: 10, fat deposition: 4. The abnormal number of hip joints was 60 in 88 patients with 176 sides of hip joint examined by CT. Among them, 35 sides of bone destruction could not be shown in X-ray plain film. 43 sides of bone destruction could not be displayed in MRI. The abnormal rate of hip joint was 18.8% (33 / 176), 34.1% (60 / 176) and 63.6% (112 / 176), respectively. MRI was superior to X-ray plane in the sensitivity of imaging showing hip involvement. CT and X _ 2 values were 73.19 and 30.74 (P < 0. 05, respectively). The patients with chronic bone structure changes in hip imaging were younger than those without chronic bone structure changes, the course of disease was shorter, and there were more hip pain or limited movement in the history (all P 0.05). The neck was the first symptom in patients with history of hip pain or limited movement, compared with those with no hip pain or limited movement. There were more chronic bone structure changes in hip imaging (all P 0.05), more regular specialist treatment in the past (P0.05), and no significant difference in the rest (P 0.05). Conclusion: in the imaging examination of AS hip joint involvement, pelvic X-ray plain film can only find middle and late lesions, and can be used to screen the disease screening X ray plain film CT and MRI can show the chronic bone structure changes of AS hip joint involvement. But the X-ray radiographic sensitivity was the best in showing the stenosis of the hip joint space, and the CT sensitivity was the best in showing the small bone destruction. The X-ray plain film and CT could not show the acute inflammatory phase changes that MRI could show. AS patients with low onset age, short course of disease and high BASFI, with history of hip pain or limited movement, were more likely to have chronic bone structure changes in hip joint imaging. Chronic bone structure changes of hip joint are not easy to occur in patients with AS with knee arthritis as the first symptom. Patients with neck pain or limited movement were less likely to suffer from hip pain or motion restriction in their history, and those with hip pain or motion limitation were more likely to suffer from chronic bone structure destruction in hip imaging. It is easier to see a doctor and receive regular specialist treatment.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R593.23
本文編號：2249559
[Abstract]:Objective: to compare the general situation, clinical manifestation, laboratory examination, imaging examination, diagnosis and treatment of AS patients. To explore the value of different imaging examination in the diagnosis of hip involvement in patients with AS and the correlation between imaging findings and clinical features. Methods: the data of general information, clinical manifestation, laboratory examination, imaging examination (pelvis plain film, CT and MRI), diagnosis and treatment of hip joint) were collected, and the results were analyzed by independent sample T test and X 2 test. Results among the 234 cases of AS, 46 sides were abnormal in MRI, 34 sides in narrow space, 15 sides in uneven density of femoral head, 20 sides in bone destruction, 10 sides in bone sclerosis, 10 sides of bone sclerosis, 34 sides of narrow gap, 15 sides of uneven density of femoral head, 20 sides of bone destruction, 10 sides of bone sclerosis. The MRI findings of 8 sides of osteomatous hyperplasia included: synovial thickening: 1 / 110, synovial thickening: 12, synovial enhancement: 21, bone marrow edema: 1: 79, tendonitis: 1, bone destruction: 15, gap narrowing: 10, fat deposition: 4. The abnormal number of hip joints was 60 in 88 patients with 176 sides of hip joint examined by CT. Among them, 35 sides of bone destruction could not be shown in X-ray plain film. 43 sides of bone destruction could not be displayed in MRI. The abnormal rate of hip joint was 18.8% (33 / 176), 34.1% (60 / 176) and 63.6% (112 / 176), respectively. MRI was superior to X-ray plane in the sensitivity of imaging showing hip involvement. CT and X _ 2 values were 73.19 and 30.74 (P < 0. 05, respectively). The patients with chronic bone structure changes in hip imaging were younger than those without chronic bone structure changes, the course of disease was shorter, and there were more hip pain or limited movement in the history (all P 0.05). The neck was the first symptom in patients with history of hip pain or limited movement, compared with those with no hip pain or limited movement. There were more chronic bone structure changes in hip imaging (all P 0.05), more regular specialist treatment in the past (P0.05), and no significant difference in the rest (P 0.05). Conclusion: in the imaging examination of AS hip joint involvement, pelvic X-ray plain film can only find middle and late lesions, and can be used to screen the disease screening X ray plain film CT and MRI can show the chronic bone structure changes of AS hip joint involvement. But the X-ray radiographic sensitivity was the best in showing the stenosis of the hip joint space, and the CT sensitivity was the best in showing the small bone destruction. The X-ray plain film and CT could not show the acute inflammatory phase changes that MRI could show. AS patients with low onset age, short course of disease and high BASFI, with history of hip pain or limited movement, were more likely to have chronic bone structure changes in hip joint imaging. Chronic bone structure changes of hip joint are not easy to occur in patients with AS with knee arthritis as the first symptom. Patients with neck pain or limited movement were less likely to suffer from hip pain or motion restriction in their history, and those with hip pain or motion limitation were more likely to suffer from chronic bone structure destruction in hip imaging. It is easier to see a doctor and receive regular specialist treatment.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R593.23
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