Rozin Alexander P, Toledano Kohava, Dagan Amir, Balbir-Gurman Alexandra
Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel.
Med Sci Monit. 2015 Feb 18;21:533-41. doi: 10.12659/MSM.892520.
The aim of this study was to measure glenohumeral joint (GHJ) parameters via the anterior access through ultrasound and to compare to data from posterior and inferior accesses.
Twenty healthy controls (M: F=15: 5, aged 45.1±11.2 years) and 16 patients (M: F=5: 11, aged 54.6±14.7 years) with active rheumatoid arthritis (RA) (DAS 28 4.6±1.2) were investigated (SonoSite-Titan). To make the GHJ visible on the anterior access, we used the original GHJ opening maneuver. The GHJ width was measured for every transducer position at 2 points. The positions were: posterior transversal, inferior longitudinal, anterior longitudinal along the articular line, anterior transversal upper, middle and lower. The joint width included thickness of cartilage plus synovial fluid/pannus. Rotator interval (RI) width and height (upper biceps channel) were measured.
Our normal GHJ values by posterior and inferior accesses were within previously estimated values (<2 mm and <3 mm, respectively). We acquired the first values of GHJ width from the anterior access. The last were within a range of 0.7-1.7 mm for healthy controls. Patients with RA showed significantly enlarged joint cavities. RI was not inflamed. Posterior and inferior data of GHJ width were significantly correlated (p=0.01). The data did not correlate with anterior values (p=+0.44, p=-0.56). Synovitis was much more prominent in posterior, upper anterior transversal, and anterior longitudinal accesses.
The GHJ may be visualized by anterior access using a special maneuver. Synovitis in the anterior region of the GHJ may develop at an independent rate. Anterior GHJ sonography may be complementary to the classic access.
本研究旨在通过超声经前路测量盂肱关节（GHJ）参数，并与经后路和经下测量的数据进行比较。
对20名健康对照者（男∶女 = 15∶5，年龄45.1±11.2岁）和16例活动性类风湿关节炎（RA）患者（男∶女 = 5∶11，年龄54.6±14.7岁，疾病活动度评分DAS28为4.6±1.2）进行了研究（使用SonoSite-Titan超声仪）。为使GHJ在经前路时可见，我们采用了原始的GHJ开口手法。在每个换能器位置的2个点测量GHJ宽度。测量位置包括：后横向、下纵向、沿关节线的前纵向、上前横向、中前横向和下前横向。关节宽度包括软骨厚度加上滑液/血管翳厚度。测量了旋转间隙（RI）宽度和高度（肱二头肌上通道）。
我们经后路和经下测量得到的正常GHJ值在先前估计值范围内（分别<2 mm和<3 mm）。我们获得了经前路测量的GHJ宽度的首个数据。健康对照者的该数据在0.7 - 1.7 mm范围内。RA患者的关节腔明显增大。RI未出现炎症。GHJ宽度的后路和经下测量数据显著相关（p = 0.01）。这些数据与经前路测量值不相关（p = +0.44，p = -0.56）。滑膜炎在经后路、上前横向和前纵向测量时更为明显。
采用特殊手法经前路可使GHJ可视化。GHJ前部区域的滑膜炎可能以独立的速率发展。经前路GHJ超声检查可能是对经典检查方法起补充作用。
