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目的了解高原地区藏族骨性关节炎(OA)患者的超声特点,探讨其发病率及高原环境对其的影响。方法对海拔3200-3800 m地区的106例因劳累、寒冷、外伤等原因,引起的掌指关节、膝、踝、髋关节疼痛等症状的OA患者,其中56例藏族患者(A组)男性32例,年龄20-76岁,平均50岁,女性24例,年龄16-82岁,平均53岁,病程1-29年,对照组(B组)50例汉族患者,男性20例,年龄40-76岁,平均57岁,女性30例,年龄20-86岁,平均54岁,病程6个月至34年。两组患者均符合2010年中华医学会风湿病学分会骨性关节炎诊断标准,常规进行高频超声检查,探查关节骨皮质、软骨、滑膜、积液、关节周围肌腱、腱鞘及血流信号等,观察软骨、滑膜改变、骨侵蚀、骨赘的部位、大小、回声及形态、关节积液等特点;并将两组发生率、关节病变的超声表现特点及变化进行统计学分析。结果106例患者中发现A组超声检查阳性率明显高于B组,其中骨侵蚀、小骨赘形成、关节腔积液及滑膜炎组间比较差异有统计学意义(P<0.01)。两组均有软骨低回声带模糊、消失、厚薄不均,骨皮质破坏、小骨赘形成等超声表现,差异有统计学意义(P<0.05),且随海拔、寒冷环境增长改变明显,发病年龄有年轻趋势,以男性为著。结论高原地区藏族OA患者有特征性变化,其软骨、骨质破坏明显,发病率明显高于汉族,且与高海拔、寒冷环境及年龄有关。超声检查对高原地区骨性关节炎藏族患者的病因诊断具有一定的临床实用价值。
Objective To understand the characteristics of Tibetan Osteoarthritis (OA) patients in the plateau, and to explore the impact of their morbidity and altitude on the environment. Methods Sixty-six OA patients with symptoms such as metacarpophalangeal joint, knee, ankle and hip joint pain caused by exertion, cold and trauma, among 56 Tibetans (group A), male 32 Cases, aged 20-76 years, mean 50 years, 24 females, aged 16-82 years, mean 53 years, duration of 1-29 years, the control group (B group) 50 Han patients, 20 males, aged 40- 76 years old, average 57 years old, 30 females, aged 20-86 years, mean 54 years old, duration of 6 months to 34 years. Both groups were in line with the diagnostic criteria of osteoarthritis of the 2010 Chinese Medical Association Rheumatology Branch, routine high-frequency ultrasound examination of cortical bone, cartilage, synovium, effusion, periarticular tendon, tendon sheath and blood flow signal The cartilage, synovial changes, bone erosion, osteophyte location, size, echogenicity and morphology, joint effusion and other characteristics were observed. The incidence and changes of ultrasound findings of the two groups were statistically analyzed. Results The positive rate of ultrasonography in group A was significantly higher than that in group B in 106 cases. There was significant difference between the two groups in terms of bone erosion, osteophyte formation, joint effusion and synovitis (P <0.01). The hypoechoic cartilage was obscured, disappeared, uneven thickness, cortical bone destruction and osteophyte formation were observed in both groups. The difference was statistically significant (P <0.05), and with the elevation of altitude, the change of cold environment changed obviously, and the age of onset A young trend, to men as. Conclusion Tibetan patients with OA in the plateau have characteristic changes, with obvious destruction of cartilage and bone. The morbidity is significantly higher than that of the Han nationality, and is related to high altitude, cold environment and age. Ultrasonography has some clinical practical value in the etiological diagnosis of Tibetan patients with osteoarthritis in the plateau region.