Yu W, Wang Y, Jiang Y, Cheng X, Wang L, Genant K
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Skeletal Radiol. 2002 Apr;31(4):222-5. doi: 10.1007/s00256-002-0475-2. Epub 2002 Feb 20.
To characterize the features and prevalence of radiographic abnormalities of the wrist in children with Kashin-Beck disease (KBD) and to determine whether the presence of radiographic abnormalities in the wrist correlates with the severity of KBD.
Two hundred and eight posteroanterior radiographs of the right hand (including wrist) in children with KBD, ranging in age from 4 to 11 years (mean age 7.7 years), from endemic areas of China were reviewed. Carpal bony margins were evaluated for blurring, thinning, irregularity with and without sclerosis, interruption, depression or destruction. The radiocarpal, intercarpal and carpometacarpal joints were assessed for widening or narrowing. The severity of the disease was graded using the hand criteria from the Chinese Radiographic Criteria of KBD Diagnosis, which classifies the following five types according to the location of the hand involved: I, metaphysis; II, diaphysis; III, I+II; IV, metaphysis and epiphysis; V, II+IV.
Of the 208 children, 95 had abnormalities in the hand but not in the wrist; 108 had both hand and wrist abnormalities; only five had abnormal wrist findings without any hand abnormalities. Of the 108 cases with wrist abnormalities, all the carpal bones were involved in 33 cases, of which the hand types were either IV or V. However, any individual carpal bone, or combination of bones, may become involved. The carpal bones most likely to show abnormalities were the capitate and the hamate (93%), followed by the triquetrum (31%), the lunate (9%), the scaphoid (6%), and the trapezoid and the trapezium (5%). The pisiform bones were not evaluated because they cannot be seen on the overlapping posteroanterior radiographs. The most commonly involved carpal joint was the midcarpal joint (42%).
Recognizing carpal abnormalities on radiographs is helpful for the diagnosis of KBD and the evaluation of the severity of the disease. The more severe the KBD, the more likely that the carpal bones will be involved. The capitate and hamate are frequently affected if the disease involves the carpal bones.
描述大骨节病（KBD）患儿腕关节影像学异常的特征及患病率，并确定腕关节影像学异常的存在是否与KBD的严重程度相关。
回顾了来自中国病区的208例年龄在4至11岁（平均年龄7.7岁）的KBD患儿右手（包括腕关节）的后前位X线片。评估腕骨边缘是否有模糊、变薄、有无硬化的不规则、中断、凹陷或破坏。评估桡腕关节、腕骨间关节和腕掌关节是否增宽或变窄。根据《大骨节病诊断X线标准》中的手部标准对疾病严重程度进行分级，该标准根据手部受累部位将其分为以下五种类型：I，干骺端；II，骨干；III，I+II；IV，干骺端和骨骺；V，II+IV。
在208例患儿中，95例手部有异常但腕关节无异常；108例手部和腕关节均有异常；仅5例腕关节有异常而手部无任何异常。在108例腕关节异常的病例中（所有腕骨均受累的有33例，其手部类型为IV或V），然而，任何单个腕骨或骨的组合都可能受累。最易出现异常的腕骨是头状骨和钩骨（93%），其次是三角骨（31%）、月骨（9%）、舟骨（6%）以及大多角骨和小多角骨（5%）。豌豆骨未进行评估，因为在重叠的后前位X线片上看不到。最常受累的腕关节是腕中关节（42%）。
认识X线片上的腕骨异常有助于大骨节病的诊断和疾病严重程度的评估。KBD越严重，则腕骨受累的可能性越大。如果疾病累及腕骨，头状骨和钩骨常受影响。
