高频超声与X线诊断膝骨关节炎价值的对比研究

摘要

目的 探讨高频超声与X线诊断膝骨关节炎的优势及局限性.方法 选取经高频超声检查符合膝骨关节炎诊断标准的102例患者(169个膝关节),行膝关节X线检查,分析并比较169个膝关节影像学表现.高频超声观察内容为:①股骨内、外侧髁关节面软骨、髁间沟软骨及软骨下骨质回声;②关节边缘骨赘;③股四头肌腱末端、髌腱回声;④内、外侧半月板回声;⑤髌上囊有无积液、滑膜有无增厚及其血流信号分布;⑥腘窝有无囊肿.X线观察内容为:①关节边缘有无骨质增生影;②胫骨髁间棘有无增生变尖;③关节间隙是否狭窄;④关节面硬化及关节面下骨囊性变情况;⑤关节囊有无肿胀.结果 对于软骨退行性改变、股四头肌腱末端及髌腱退行性改变、关节腔积液、滑膜增生、胭窝囊肿等非骨性结构改变方面,高频超声具有良好分辨率,敏感度分别为0.862、0.853、0.985、0.912和0.928,特异度分别为0.936、0.916、0.968、0.954、0.962;对于关节边缘骨质增生、关节间隙狭窄及关节面下骨囊性变等骨性结构改变,X线较高频超声具有优势,敏感度分别为0.937、0.925、0.822,特异度分别为0.958、0.865、0.881.超声声像图显示股骨远端髁间沟内侧斜面软骨厚度低于髁间沟外侧斜面[(0.8 ±0.4)mm比(1.2 ±0.6)mm],差异有统计学意义(P＜0.05).结论 高频超声与X线二者互为补充,结合应用可以全面评价膝骨关节炎的病变程度和范围.%Objective To investigate the advantages and limitations of high-frequency ultrasound and X-ray in diagnosis of keen osteoarthritis.Methods A total of 102 patients (including 169 keen joints) with knee osteoarthritis confirmed by high-frequency ultrasound underwent X-ray.The following items of high-frequency ultrasound were observed:①echo of articular cartilage and articular surface of bone in internal,lateral condyle of femur and intercondylar groove;②osteophytes in the edge of joint;③echo of the distal quadriceps tendon and patellar tendon;④echo of the meniscus;⑤the situation of effusion,synovial thickening and blood flow distribution in suprapatellar bursa;⑥baker's cyst.The following items of X-ray were observed:①osteophytes in the edge of joint;②osteophytes in intercondylar spine of tibia;③joint space;④the situation of articular surface hardening and bone cysts in articular facet;⑤joint capsule swelling.Results High-frequency ultrasound had high resolution in cartilage degenerative changes of distal femur,quadriceps femoris muscle and patellar tendon,which was also detected in non-bony structures changes including articular cavity effusion,synovitis and popliteal cyst,with sensitivities of 0.862,0.853,0.985,0.912,0.928 and specificities of 0.936,0.916,0.968,0.954,0.962,respectively.X-ray had a higher sensitivity compared with high-frequency ultrasound in osseous structure changes,including joint edge osteoarthritis,joint space narrowing and cystic changes in bone under the joint surface,with sensitivities of 0.937,0.925,0.822 andthe specificities of 0.958,0.865,0.881,respectively.The thickness of cartilage in internal condyle of femur was less than that in lateral condyle of femur in ultrasound imaging [(0.8 ± 0.4) mm vs (1.2 ± 0.6) mm] (P ＜ 0.05).Conclusion The combination of high-frequency ultrasound and X-ray can comprehensively assess the scope and severity of knee osteoarthritis.