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目的研究阿坝州壤塘县藏区大骨节病(Kashin-Beck disease,KBD)多个大关节受累与分度之间的相关关系,探索成人大骨节病的合理分级标准,指导临床治疗的可行性。方法由骨科、风湿免疫科和地方病专家联合研究组设计专用调查表,采用现场流行病学调查法,包括一般情况、关节疼痛、视觉模拟疼痛评分(visual analoguescale,VAS)、关节畸形和功能障碍等,随机调查阿坝州壤塘县6个村24～93岁藏族成人大骨节病患者81例,按我国关于成人大骨节病分度标准:Ⅰ度30例,Ⅱ度30例,Ⅲ度21例。大关节定义为肩、肘、腕、髋、膝、踝共12个关节,其中任何一个关节出现疼痛、畸形或功能障碍即为大关节受累。分别统计Ⅰ、Ⅱ、Ⅲ度大骨节病患者大关节受累关节数和VAS评分。结果全部患者均存在2个以上大关节受累,其中肘关节和膝关节受累最多见,9～12个大关节受累在成人大骨节病Ⅱ度患者中比例最高,肘关节和膝关节疼痛VAS评分在成人大骨节病Ⅱ度患者中最高,踝关节受累和疼痛在Ⅲ度成人大骨节病患者中最重,肩、腕、髋关节受累及VAS评分在Ⅰ、Ⅱ、Ⅲ度成人大骨节病患者间无统计学差异,4个以上大关节受累人数在Ⅰ、Ⅱ、Ⅲ度成人大骨节病患者间无统计学差异。结论壤塘县藏区成人大骨节病患者常存在多个大关节受累,大关节受累的比例和程度与目前大骨节病分度之间无统一性;有必要对目前成人大骨节病分度进行合理的修订或改进、完善,使之更符合临床诊治并合理指导成人大骨节病的临床治疗。
Objective To study the relationship between Kashin-Beck disease (KBD) involvement and indexing in Zangtang County, Aba Prefecture, China, and to explore the reasonable grading criteria of adult Kashin-Beck disease and to guide the feasibility of clinical treatment . Methods Specific questionnaires were designed by a joint study group of orthopedics, rheumatology and endemic specialists using on-site epidemiological investigations including general conditions, joint pain, visual analoguescale (VAS), joint deformities and dysfunctions , Randomly investigated 81 adult patients with Kaschin-Beck disease in 24 villages aged 6 ~ 93 in Dangtang County, Aba Prefecture. According to our country’s criteria for adult Kaschin-Beck disease, there were 30 cases of degree Ⅰ, 30 cases of degree Ⅱ and 21 cases of degree Ⅲ. Large joint is defined as shoulder, elbow, wrist, hip, knee, ankle a total of 12 joints, any joint pain, deformities or dysfunction that is involved in the joints. The numbers of joint involvement and VAS scores of major joints in patients with Kashin-Beck disease were calculated respectively. Results All patients had more than two major joint involvement, of which elbow and knee joint involvement was the most common, 9 ~ 12 major joint involvement was the highest among patients with adult KBD, and VAS score of elbow joint and knee joint pain was Adults with Kaschin-Beck disease have the highest II degree, with ankle involvement and pain being the heaviest among adults with KBD. Patients with shoulder, wrist, and hip involvement and VAS scores are among those with adult Kaschin-Beck disease No statistical difference, more than 4 large joints involved in Ⅰ, Ⅱ, Ⅲ degree of adult patients with Kaschin-Beck disease was no significant difference. Conclusion There are many large joints involved in adult patients with Kashin-Beck disease in Zangtang County. There is no unity between the proportion and degree of involvement of the large joints and the current degree of Kashin-Beck disease. It is necessary to classify the present adult KBD patients Reasonable to amend or improve, improve, so that it is more in line with clinical diagnosis and treatment and reasonable guidance adult Kashin-Beck disease clinical treatment.