何勇;胡军林;顾湘杰;欧阳桂林;肖涟波;夏卿;黄正;韩大鹏;朱飞;孙松涛;

• 1:上海市长宁区光华中西医结合医院关节外科
• 2:复旦大学附属华山医院骨科

摘要(Abstract)：

[目的]调查类风湿性关节炎(rheumatoid arthritis,RA)患者的肩关节功能及影像学改变,了解该类人群中肩关节病变现状,分析肩关节破坏的相关因素,为RA肩部疾病的预防和治疗提供临床依据。[方法]随机选择RA患者,记录发病年龄、病程,采用ASES肩关节评分量表评测肩关节功能;拍摄肩关节正位X线片,进行Larson分期,测量肩关节内侧距离(MD)、肩关节上移指数(UI)、肩关节內移指数(MI)、大结节关节面间距(GA),分析Larson分期与上述数据间的相关性。[结果]2010年3月～2010年11月,60人入选本研究,平均年龄(51.34±14.14)岁,男6人,女54人。ASES评分(72.69±24.76)分;完成116肩摄X线片,无明显骨性破坏的肩关节(Larson 0～1期)MD为(7.55±0.55)cm,UI为1.38±0.10,MI为1.04±0.29,GA为(0.60±0.22)cm。Larson分期与ASES评分呈显著负相关(r=-0.028 3,P=0.001),与反映肩关节内移的MD、MI呈显著负相关(r=-0.177,P=0.029和r=-0.438,P<0.001);与UI无显著相关性(r=-0.062,P=0.253);与GA呈显著负相关(r=-0.369,P<0.001)。与病程和年龄呈显著正相关(r=0.534和r=0.390,P<0.001),与患病年龄无显著相关性(r=0.091,P=0.165)。[结论]肩关节受累在RA患者中广泛存在,其受累程度随着病程增加而增加,随着破坏程度的加剧肩关节旋转中心发生内移,但是尚不明确旋转中心上移与骨性破坏是否同步发展。

关键词(KeyWords)： 类风湿性关节炎;肩关节;影像学测量

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 何勇;胡军林;顾湘杰;欧阳桂林;肖涟波;夏卿;黄正;韩大鹏;朱飞;孙松涛;

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参考文献(References)：

• [1]Chapman M.Chapman’s orthopaedic surgery[M].3rd e-d.Phylidalphina:Lippincott Williams&Wilkins,2001:3096-3121.
• [2]Harris ED.Clinical features of rheumatoid arthritis[M]//Textbookof rheumatology.Philadelphia:Saunders,1997:898-932.
• [3]Cuomo F,Greller MJ,Zuckerman JD.The rheumatoid shoulder[J].Rheum Dis Clin North Am,1998,24:67-82.
• [4]Hermann KG,Backhaus M,Schneider U,et al.Rheumatoid arthritisof the shoulder joint:comparison of conventional radiography,ul-trasound,and dynamic contrast-enhanced magnetic resonanceimaging[J].Arthritis Rheum,2003,48:3338-3349.
• [5]Olofsson Y,Book C,Jacobsson LT.Shoulder joint involvement in pa-tients with newly diagnosed rheumatoid arthritis.Prevalence andassociations[J].Scand J Rheumatol,2003,32:25-32.
• [6]Thomas T,Nol E,Goupille P,et al.The rheumatoid shoulder:cur-rent consensus on diagnosis and treatment[J].Joint Bone Spine,2006,2:139-143.
• [7]Sokka T.Radiographic scoring in rheumatoid arthritis-a short in-troduction to the methods[J].Bulletin of the NYU Hospital forJoint Diseases,2008,2:166-168.
• [8]Schill S,Thabe H,Grifka J.Differential therapy for the rheumatoidshoulder[J].Orthopade,2002,12:1132-1144.
• [9]Levigne C,Franceschi JP.Rheumatoid shoulder.Radiographic form-sand results of shoulder arthroplasty.About 50 cases[M]//WalchG,Boileau P.Shoulder arthroplasty.Berlin:Springer,1999:221-232.
• [10]Lehtinen JT,Belt EA,Kauppi MJ,et al.Bone destruction,upwardmigration,and medialisation of rheumatoid shoulder:a 15 yearfollow up study[J].Ann Rheum Dis,2001,4:322-326.
• [11]Lehtinen JT,Belt EA,Lybck CO,et al.Subacromial space in rheu-matoid shoulder.A radiographic 15 year follow up study of 148shoulders[J].J Shoulder Elbow Surg,2000,9:183-187.
• [12]Sanja MR,Mirjana ZS.Ultrasonographic study of the painful shoul-der in patients with rheumatoid arthritis and patients with degen-erative shoulder disease[J].Acta Reumatol Port,2010,1:50-58.
• [13]Kim HA,Kim SH,Seo YI.Ultrasonographic findings of the shoul-der in patients with rheumatoid arthritis and comparison withphysical examination[J].J Korean Med Sci,2007,4:660-666.
• [14]张亚非,黄庆森.肩袖损伤的诊断和治疗进展[J].中国矫形外科杂志,2007,2:127-130.