风湿性疾病中的肩部受累。超声检查结果。

Shoulder involvement in rheumatic diseases. Sonographic findings.

作者信息

Coari G, Paoletti F, Iagnocco A

机构信息

Department of Rheumatology, University of Rome La Sapienza, Italy.

出版信息

J Rheumatol. 1999 Mar;26(3):668-73.

PMID:10090180

Abstract

OBJECTIVE

To distinguish using shoulder sonography the different changes present in rheumatoid arthritis (RA), polymyalgia rheumatica (PMR), and periarticular disorders (PD) of soft tissue of the shoulder.

METHODS

Ninety shoulders of patients with RA, 32 with PMR, 122 with PD, and 108 controls were studied sonographically, using a 7.5 MHz linear probe. The following structures were evaluated: long head of biceps tendon, supraspinatus, infraspinatus and subscapularis tendons, subacromial and subscapularis bursae, rotator cuff (thickness), calcifications, and glenohumeral and acromioclavicular joints. Statistical analysis was by Student's t test and chi-squared test.

RESULTS

Involvement of long head of biceps tendon (peritendinous fluid collection, changes of thickness, and/or echotexture) was significantly different between RA and PMR and between PD and PMR. Alterations in thickness and/or fibrillar pattern were evaluated in rotator cuff tendons: supraspinatus tendon was involved with significant differences between PD and both RA and PMR; the changes of subscapularis tendon were present, with significant differences between PD and both the other groups; the alterations of infraspinatus tendon were not statistically different between the 3 groups. Effusion within bursae was present, with significant differences only between RA and PD. The mean thickness of rotator cuff was significantly different between controls (6.2 mm) and both PD (5.3 mm) and RA (5.8 mm), and between PMR (6 mm) and PD. Evaluation of effusion within the glenohumeral joint (capsule-bone distance) showed significant differences between controls (2.4 mm) and both RA (4.2 mm) and PMR (4 mm), between RA and PD (2.6 mm), and between PMR and PD. Calcifications were present only in PD (21.3%) and RA (6.7%), with significant differences. Effusion within the acromioclavicular joint was present in RA (35.5%) and PD (20.5%), with significant differences.

CONCLUSION

Shoulder sonography showed involvement of all structures in RA, the prevalence of effusion in PMR, and involvement mainly of tendons in PD.

摘要

目的

运用肩部超声检查来区分类风湿关节炎（RA）、风湿性多肌痛（PMR）以及肩部软组织关节周围疾病（PD）中存在的不同变化。

方法

使用7.5兆赫线性探头对90例RA患者的肩部、32例PMR患者的肩部、122例PD患者的肩部以及108例对照者的肩部进行超声检查。对以下结构进行评估：肱二头肌长头肌腱、冈上肌、冈下肌和肩胛下肌腱、肩峰下和肩胛下滑囊、肩袖（厚度）、钙化以及盂肱关节和肩锁关节。采用学生t检验和卡方检验进行统计分析。

结果

肱二头肌长头肌腱受累情况（肌腱周围积液、厚度变化和/或回声纹理）在RA与PMR之间以及PD与PMR之间存在显著差异。对肩袖肌腱的厚度和/或纤维模式变化进行了评估：冈上肌腱受累，在PD与RA和PMR之间存在显著差异；肩胛下肌腱有变化，在PD与其他两组之间存在显著差异；冈下肌腱的变化在三组之间无统计学差异。滑囊内有积液，仅在RA与PD之间存在显著差异。肩袖的平均厚度在对照组（6.2毫米）与PD组（5.3毫米）和RA组（5.8毫米）之间以及PMR组（6毫米）与PD组之间存在显著差异。对盂肱关节内积液（关节囊 - 骨距离）的评估显示，对照组（2.4毫米）与RA组（4.2毫米）和PMR组（4毫米）之间、RA组与PD组（2.6毫米）之间以及PMR组与PD组之间存在显著差异。钙化仅出现在PD组（21.3%）和RA组（%），存在显著差异。肩锁关节内积液出现在RA组（35.5%）和PD组（20.5%），存在显著差异。