Backhaus M, Schmidt W A, Mellerowicz H, Bohl-Bühler M, Banzer D, Braun J, Sattler H, Hauer R W
Universitätsklinikum Charitè Campus Mitte Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie Humboldt-Universität zu Berlin Schumannstrasse 20/21 10117 Berlin, Germany.
Z Rheumatol. 2002 Aug;61(4):415-25. doi: 10.1007/s00393-002-0346-1.
Musculoskeletal ultrasonography is an important imaging technique in the diagnosis of rheumatic diseases especially for early manifestation. It allows sensitive detection of small joint fluid collections as well as differentiation of soft tissue lesions and bone lesions. The following standard scans are suggested for sonographic evaluation of the elbow: 1) anterior humeroradial longitudinal scan, 2) anterior humeroulnar longitudinal scan to detect effusions, synovial proliferation, loose joint bodies, bone lesions (osteoarthritis/arthritis), 3) anterior transverse scan over the trochlea to evaluate these structures in an additional dimension, 4) posterior longitudinal scan and 5) posterior transverse scan of the olecranon fossa with flexed/extended elbow to evaluate the same objectives as the above mentioned scans and additionally to detect olecranon bursitis, and optional 6) distal dorsal longitudinal scan to differentiate soft tissue lesions such as rheumatoid nodules or gout tophi, 7) anterior transverse scan over the radius head to evaluate lesions of the radius head, tendopathy, calcinosis, 8) lateral humeroradial longitudinal scan to evaluate epicondylitis, 9) medial humeroulnar longitudinal scan to evaluate calcinosis, epicondylitis, signs of compression of the ulnar nerve. A linear transducer with a frequency of about 5-7.5 MHz is recommendable. The anterior distance between trochlea and the capitulum of the humerus between the bone and the joint-capsule of the elbow is > or = 2 mm in probable and > or = 3 mm in definite synovitis or effusions. Synovitis or effusions are probable if the difference between the right and left elbow is 1 mm, and they are definite if the difference is > or = 2 mm.
肌肉骨骼超声检查是诊断风湿性疾病尤其是早期表现的重要成像技术。它能够灵敏地检测小关节积液，还能区分软组织病变和骨病变。对于肘部的超声评估，建议进行以下标准扫描：1）肱桡关节前纵扫；2）肱尺关节前纵扫，以检测积液、滑膜增生、关节游离体、骨病变（骨关节炎/关节炎）；3）在滑车上方进行前横扫，从另一个维度评估这些结构；4）后纵扫；5）屈肘/伸肘时鹰嘴窝的后横扫，以评估与上述扫描相同的目标，此外还可检测鹰嘴滑囊炎，以及可选的6）远端背侧纵扫，以区分软组织病变，如类风湿结节或痛风石；7）桡骨头上方的前横扫，以评估桡骨头病变、肌腱病、钙质沉着；8）肱桡关节外侧纵扫，以评估肱骨外上髁炎；9）肱尺关节内侧纵扫，以评估钙质沉着、肱骨内上髁炎、尺神经受压体征。推荐使用频率约为5 - 7.5 MHz的线性探头。在可能存在滑膜炎或积液时，肱骨滑车与小头之间、肘部骨骼与关节囊之间的前侧距离≥2 mm，确诊滑膜炎或积液时该距离≥3 mm。如果左右肘部的差异为1 mm，则可能存在滑膜炎或积液；如果差异≥2 mm，则可确诊。
