Buckland-Wright J C, Macfarlane D G, Lynch J A, Clark B
Anatomy Department, United Medical School of Guy's Hospital, London, United Kingdom.
Arthritis Rheum. 1990 Jan;33(1):57-65. doi: 10.1002/art.1780330107.
We studied 32 patients with osteoarthritis who had 5x macroradiographs taken of their wrists and hands at 6-month intervals over an 18-month period. The higher magnification and resolution of microfocal radiography permitted the quantitative detection of progressive changes in 4 different features: subchondral sclerosis, the number and size of osteophytes, juxtaarticular radiolucencies, and joint space narrowing. Compared with normal control subjects, subchondral cortical thickness was greater in all patients at entry and showed a variable degree of change over the study period. Osteophytes and juxtaarticular radiolucencies were present in all patients at study entry; by the end of the study, osteophytes had increased in number and area, and juxtaarticular radiolucencies had increased in area, but not in number. At entry, 44% of the patients had joint space narrowing significantly greater than that in the control subjects; by 18 months, this proportion increased to 65%. No correlation was found between subchondral sclerosis, osteophytes, juxtaarticular radiolucencies, and joint space narrowing. We conclude that in osteoarthritis of the hand, the bony changes have progressed significantly before the occurrence of radiographically evident joint space narrowing indicative of cartilage thinning.
我们研究了32例骨关节炎患者，在18个月的时间里，每隔6个月对他们的手腕和手部进行5倍放大的X线片拍摄。微焦点X线摄影更高的放大倍数和分辨率能够定量检测4种不同特征的进展性变化：软骨下硬化、骨赘的数量和大小、关节周围透亮区以及关节间隙变窄。与正常对照受试者相比，所有患者在入组时软骨下皮质厚度均更大，且在研究期间呈现出不同程度的变化。所有患者在研究入组时均存在骨赘和关节周围透亮区；到研究结束时，骨赘的数量和面积增加，关节周围透亮区的面积增加，但数量未增加。入组时，44%的患者关节间隙变窄明显大于对照组；到18个月时，这一比例增至65%。未发现软骨下硬化、骨赘、关节周围透亮区与关节间隙变窄之间存在相关性。我们得出结论，在手部骨关节炎中，在影像学上出现提示软骨变薄的明显关节间隙变窄之前，骨质变化就已显著进展。
