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[目的]调查类风湿性关节炎(rheumatoid arthritis,RA)患者的肩关节功能及影像学改变,了解该类人群中肩关节病变现状,分析肩关节破坏的相关因素,为RA肩部疾病的预防和治疗提供临床依据。[方法]随机选择RA患者,记录发病年龄、病程,采用ASES肩关节评分量表评测肩关节功能;拍摄肩关节正位X线片,进行Larson分期,测量肩关节内侧距离(MD)、肩关节上移指数(UI)、肩关节內移指数(MI)、大结节关节面间距(GA),分析Larson分期与上述数据间的相关性。[结果]2010年3月～2010年11月,60人入选本研究,平均年龄(51.34±14.14)岁,男6人,女54人。ASES评分(72.69±24.76)分;完成116肩摄X线片,无明显骨性破坏的肩关节(Larson 0～1期)MD为(7.55±0.55)cm,UI为1.38±0.10,MI为1.04±0.29,GA为(0.60±0.22)cm。Larson分期与ASES评分呈显著负相关(r=-0.028 3,P=0.001),与反映肩关节内移的MD、MI呈显著负相关(r=-0.177,P=0.029和r=-0.438,P<0.001);与UI无显著相关性(r=-0.062,P=0.253);与GA呈显著负相关(r=-0.369,P<0.001)。与病程和年龄呈显著正相关(r=0.534和r=0.390,P<0.001),与患病年龄无显著相关性(r=0.091,P=0.165)。[结论]肩关节受累在RA患者中广泛存在,其受累程度随着病程增加而增加,随着破坏程度的加剧肩关节旋转中心发生内移,但是尚不明确旋转中心上移与骨性破坏是否同步发展。
[Objective] To investigate the changes of shoulder joint function and radiology in patients with rheumatoid arthritis (RA), to understand the status of shoulder joint disease in this kind of population, to analyze the related factors of shoulder joint destruction and to prevent RA shoulder disease And provide clinical basis for treatment. [Methods] The RA patients were randomly selected and the age and course of disease were recorded. The function of shoulder joint was evaluated by using ASES shoulder joint scoring scale. Shoulder joint orthopedic radiographs were taken and Larson staging was performed. The medial shoulder distance (MD) (UI), intra-articular index (MI), and articular surface of large nodules (GA). The correlation between Larson staging and the above data was analyzed. [Results] From March 2010 to November 2010, 60 patients were enrolled in this study. The mean age was (51.34 ± 14.14) years old, 6 males and 54 females. The ASES score was (72.69 ± 24.76) points. Shoulder radiography was performed on 116 shoulders radiographs (Larson stage 0 ~ 1) without apparent bone destruction (7.55 ± 0.55 cm), with UI of 1.38 ± 0.10 and MI of 1.04 ± 0.29, GA was (0.60 ± 0.22) cm. There was a significant negative correlation between Larson staging and ASES score (r = -0.028 3, P = 0.001), but negatively correlated with MD and MI (r = -0.177, P = 0.029 and r = -0.438, P <0.001). There was no significant correlation with UI (r = -0.062, P = 0.253). There was a significant negative correlation with GA (r = -0.369, P <0.001). There was a significant positive correlation between disease duration and age (r = 0.534 and r = 0.390, P <0.001), but no significant correlation with disease age (r = 0.091, P = 0.165). [Conclusion] Shoulder joint involvement is widespread in patients with RA, and the degree of involvement increases with the course of disease. As the degree of disruption aggravates the rotation of the shoulder joint, the shift of the center of rotation occurs. However, it is unclear whether the upturn of the rotation center and the destruction of bone are Synchronous development.