Lehtinen J T, Kaarela K, Kauppi M J, Belt E A, Mäenpää H, Kuusela P, Lehto M U
Rheumatism Foundation Hospital, Heinola, Finland.
Ann Rheum Dis. 2001 Aug;60(8):765-9. doi: 10.1136/ard.60.8.765.
To evaluate the nature of positional changes of humeroulnar (HU) and humeroradial (HR) joints in a cohort of 74 patients with seropositive and erosive rheumatoid arthritis (RA) followed up prospectively.
At the 15 year follow up standard anteroposterior and lateral radiographs of 148 elbow joints were evaluated. The mediolateral HU angle of the elbow was measured from anteroposterior radiographs. The proximal subluxation of the HU joint was measured from lateral radiographs as the distance between the posterior aspect of the olecranon process and the posterior surface of the humerus. The anteroposterior subluxation of the HR joint was measured from lateral radiographs as the relation of the midpoint of head of the radius to the midpoint of the capitellum of the humerus. Destruction of the elbow joints was assessed with the Larsen method on a scale of 0 to 5 and compared with the measurements.
Mean HU angle in 148 elbows of patients with RA was 11.5 degrees (SD 6.1), range -21 degrees (varus) to 34 degrees (valgus); 9.9 degrees (SD 4.3) in men and 12.0 degrees (SD 6.4) in women. The mean HU angle, 14.4 degrees (SD 6.0) of the affected joints (Larsen grades 2-4), showed more valgus than the mean 9.8 degrees (SD 2.5) of the non-affected (Larsen grades 0 to 1) joints; totally destroyed and unstable Larsen 5 joints were excluded. Mean HU and HR subluxations, 2.0 mm (SD 3.8) and 0.8 mm, of the affected joints (Larsen 2-5) were greater than the means, -1.1 mm (SD 1.5) and -0.4 mm (SD 0.9), of the non-affected joints. Both the HU proximal subluxation and the HR anterior subluxation correlated, r(s)=0.64 (95% CI 0.53 to 0.73 ) and r(s)=0.48 (95% CI 0.34 to 0.60), with the destruction of the elbow joint.
The elbow seems to turn into valgus during rheumatoid destruction and excision of the radial head may speed up this process. However, totally unstable Larsen grade 5 joints may also have varus deformity owing to mutilating bone destruction. The ulna subluxates proximally in relation to the humerus, whereas the radius moves slightly anteriorly as a consequence of elbow involvement.
对74例血清学阳性且有侵蚀性类风湿关节炎（RA）患者进行前瞻性随访，评估其肱尺（HU）关节和肱桡（HR）关节位置变化的特点。
在15年随访时，对148个肘关节的标准前后位和侧位X线片进行评估。从前后位X线片测量肘关节的内外侧HU角。从侧位X线片测量HU关节的近端半脱位，即鹰嘴突后缘与肱骨干后表面之间的距离。从侧位X线片测量HR关节的前后位半脱位，即桡骨头中点与肱骨小头中点的关系。采用Larsen方法将肘关节破坏程度分为0至5级，并与测量结果进行比较。
RA患者148个肘关节的平均HU角为11.5度（标准差6.1），范围为-21度（内翻）至34度（外翻）；男性为9.9度（标准差4.3），女性为12.0度（标准差6.4）。受累关节（Larsen分级2 - 4级）的平均HU角为14.4度（标准差6.0），比未受累关节（Larsen分级0至1级）的平均9.8度（标准差2.5）更偏向外翻；完全破坏且不稳定的Larsen 5级关节被排除。受累关节（Larsen 2 - 5级）的平均HU和HR半脱位分别为2.0毫米（标准差3.8）和0.8毫米，大于未受累关节的平均值，分别为-1.1毫米（标准差1.5）和-0.4毫米（标准差0.9）。HU近端半脱位和HR前半脱位与肘关节破坏程度均呈相关性，Spearman秩相关系数分别为r(s)=0.64（95%可信区间0.53至0.73）和r(s)=0.48（95%可信区间0.34至0.60）。
类风湿性破坏过程中肘关节似乎会变成外翻，桡骨头切除可能会加速这一过程。然而，由于严重的骨质破坏，完全不稳定的Larsen 5级关节也可能出现内翻畸形。尺骨相对于肱骨向近端半脱位，而桡骨因肘关节受累而略微向前移位。
