摘要：目的：研究旨在探讨晶体诱导的关节炎患者肩关节超声下的形态结构改变情况。分析它们之间的相关性及与临床表现之间的相关性。方法：该研究为一项多中心研究，收集88例来自意大利4个风湿病部门的住院或门诊患者，所有患者经晶体证实为痛风或假性痛风（CPPD）患者。所有患者（除外存在或不存在自发性肩痛的患者）由1名专业的风湿病医师进行临床检查，记录临床和实验室检查数据。所有患者进行Hawkins、Jobe,Patte、Gerber和Speed检测。在每一个中心，由风湿病专家（不知道患者临床数据情况）进行肩关节超声检查，使用仪器为MyLabTWICEXVG（EsaoteSpA,Genoa,Italy）（线性探头频率为4-13MHz）以及Logiq9（GeneralElectricsMedicalSystems,Milwaukee,WI,USA）（线性探头频率为9-14MHz）。探讨关节周围炎、肩袖撕裂病理学和关节受累情况，并揭示晶体沉积时的超声征象。结果：研究纳入88例患者，39例为痛风患者，46例为CPPD患者，3例为痛风合并CPPD患者。对个肩关节进行检查发现，54/（30％）个为疼痛关节，74/（42％）个为正常关节。所有结果表明CPPD患者关节周围滑膜炎发生率高于痛风患者。50/（28.4％）个肩关节至少有一种超声表现证实为滑膜炎。痛风和CPPD患者肌腱端病都是最常见的超声改变，最常累及均为冈上肌腱。CPPD患者冈上肌腱断裂的发生率比痛风患者高出7倍。80％的CPPD患者及60％的痛风患者肩锁关节发现骨质增生。结论：本研究证实，晶体沉积在透明软骨上是超声特异性表现。晶体诱导的关节炎患者肩关节受累通常表现为冈上肌腱和肩锁关节纤维软骨形态结构改变。
附原文：
Abstract：OBJECTIVES:Thisstudywasaimedatdeterminingtheprevalenceofultrasound(US)morpho-structuralchangesintheshouldersofpatientswithcrystal-relatedarthropathies,andatinvestigatingtherelationshipbetweenthemandtheclinicalfindings.METHODS:Eighty-eightpatientswithacrystalprovendiagnosisofgoutorcalciumpyrophosphatedihydrate(CPPD)diseaseattendingthein-patientandtheout-patientclinicsoffourItalianRheumatologyDepartmentswereconsecutivelyenrolledinthismulti-centrestudy.Allpatientswereclinicallyexaminedbyanexpertrheumatologistwhorecordedclinicalandlaboratorydatainadditiontothepresence/absenceofspontaneousshoulderpainandperformedtheHawkins,Jobe,Patte,Gerber,andSpeedtests.Ineachcentre,USexaminationswerecarriedoutbyarheumatologistexpertinmusculoskeletalUSblindedtoclinicaldata,usingaMyLabTWICEXVGmachine(EsaoteSpA,Genoa,Italy)equippedwithalinearprobeoperatingat4-13MHz,andaLogiq9machine(GeneralElectricsMedicalSystems,Milwaukee,WI,USA)withalinearprobeoperatingat9-14MHz.Shoulderswerescannedtodetectperi-articularinflammation,rotatorcuffpathologyandjointinvolvement,andtorevealUSsignsindicativeofcrystaldeposits.RESULTS:Atotalof88patients,39withgout,46withCPPDdisease,and3withbothgoutandCPPDdisease,wereenrolled.Intotal,shoulderswereclinicallyassessed,ofwhich54/(30%)werepainfuland74/(42%)wereclinicallynormalshoulders.AllUSfindingsindicativeofperi-articularsynovialinflammationweremorefrequentlydetectedinpatientswithCPPDdiseasethaningoutypatients.In50outof(28.4%)shoulders,USallowedthedetectionofatleastonefindingindicativeofsynovialinflammation.ChronictendinopathywasafrequentUSfindingbothingoutpatientsandinpatientswithCPPDdiseaseandthesupraspinatustendonwasthemostfrequentlyinvolvedone.InCPPDdiseasethesupraspinatustendonwasfoundrupturedinanumberofshouldersseventimeshigherthaningoutypatients.Theosteophyteswerefoundatacromion-clavicularjointinnearly80%oftheshouldersinCPPDdiseaseandin60%inthegoutypatients.CONCLUSIONS:TheresultsofthisstudyconfirmthehighspecificityofUSfindingsindicativeofcrystaldepositsathyalinecartilagelevelandindicatethatthesupraspinatustendonandthefibrocartilageoftheacromion-clavicularjointarethemostfrequentlyaffectedstructuresoftheshouldersinpatientswithcrystal-relatedarthropathies.
引自：FilippucciE,DelleSedieA,RienteLetal.Ultrasoundimagingfortherheumatologist.XLVII.Ultrasoundoftheshoulderinpatientswithgoutandcalciumpyrophosphatedepositiondisease.ClinExpRheumatol.Sep-Oct;31(5):-64.
注：文中图片摘自网络
