摘要
目的观察分析膝骨关节炎(KOA)肌肉骨骼超声表现与中医证型的相关性,为形成可推广的中医辨证诊疗方案提供依据。方法选取2019年7月至2021年3月期间就诊于上海市光华中西医结合医院风湿病科门诊的KOA患者,收集患者的一般资料情况,并依据《中医骨伤科临床诊疗指南·膝痹病(膝骨关节炎)》进行中医辨证分型判断,然后分别观察不同证型患者的肌肉骨骼超声表现情况,包括关节软骨损伤(包括软骨厚度及超声US分级)、滑膜增生(包括滑膜厚度及增生区血流信号)、关节腔积液及腘窝囊肿发生情况,分析中医证型与各个超声表现之间的相关性。结果共收集到KOA患者102例,其中肝肾亏虚证38例,湿热痹阻证29例,寒湿痹阻证24例,气滞血瘀证8例,气血虚弱证3例。气血虚弱证患者软骨厚度最小,US分级多见于0~Ⅱ级,寒湿痹阻证及湿热痹阻证可见Ⅲ级,气血虚弱证可见Ⅳ级;湿热痹阻证患者滑膜厚度最大,各个证型的增生区血流信号均为0级或Ⅰ级,未见Ⅱ、Ⅲ级,但不同证型增生区血流信号异常率各有不同,气血虚弱证、寒湿痹阻证、湿热痹阻证的异常率相对较高;寒湿痹阻证患者关节腔积液最为明显,其次是湿热痹阻证;除气血虚弱证外,其余证型均有腘窝囊肿的发生,但不同证型腘窝囊肿的发生率各有不同,寒湿痹阻证患者腘窝囊肿发生率相对较高。通过Spearman相关性分析显示,中医证型与增生区血流信号和关节腔积液具有正相关性(P<0.05)。结论肌肉股骨超声检查可以协助临床医生对KOA病情进行评估,也能够为KOA的中医辨证提供一定的客观依据,其中滑膜增生区血流信号和关节积液情况可作为KOA中医辨证分型的参考指标。
Objective To study the correlation between musculoskeletal ultrasonography(MSUS)and traditional Chinese medicine(TCM)syndrome of knee osteoarthritis(KOA),and to provide the basis for TCM syndrome differentiation.Methods From July 2019 to March 2021,the general information of the patients were collected who were treated in the Rheumatology Department of ShangHai GuangHua Hospital of Integrated Traditional Chinese and Western Medicine.TCM syndrome differentiation of these patients were assessed according to Clinical Guidelines for Diagnosis and Treatment of Knee Osteoarthritis(Xibibing)in Orthopedics and Traumatology of Traditional Chinese Medicine.The key observation was different musculoskeletal manifestations,including articular cartilage damage(cartilage thickness and ultrasound[US]grading),synovial proliferation(including synovial thickness and blood flow signals in proliferative zone),arthroedema and popliteal cyst.The correlation between MSUS and TCM syndrome types was analyzed.Results Among 102 KOA patients,there was 38 cases of liver-kidney deficiency syndrome,29 cases of damp-heat obstruction syndrome,24 of cold-dampness obstruction syndrome,8 cases of qi-stagnancy and blood stasis,and 3 cases of qi-blood deficiency.The Minimum cartilage thickness was found in patients with qi-blood deficiency with common US grading 0-Ⅱ,cold-dampness obstruction syndrome and damp-heat obstruction syndrome for gradeⅢ,and qi-blood deficiency syndrome for gradeⅣ.The maximum synovial thickness was found in patients with damp-heat obstruction syndrome.The blood flow signals in proliferative zone of each syndrome type were grade 0 orⅠ,and no gradeⅡorⅢwas found,but the abnormal rate of blood flow signal was relatively high in qi-blood deficiency syndrome,cold-dampness obstruction syndrome,damp-heat obstruction syndrome.The arthroedema maximum value was found in patients with cold-dampness obstruction syndrome,followed by damp-heat obstruction syndrome;the occurrence of popliteal cysts was found in syndromes except fo
作者
秦盈盈
姜婷
何东仪
许曼珊
范鋆钰
QIN Yingying;JIANG Ting;HE Dongyi;XU Manshan;FAN Junyu(Department of Rheumatology,Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai 2000522;Shanghai University of Traditional Chinese Medicine,Shanghai 201203)
出处
《河北中医》
2022年第7期1084-1088,共5页
Hebei Journal of Traditional Chinese Medicine
基金
2019年度上海中医药大学预算内科研项目(编号:2019LK054)。
关键词
骨关节炎
膝
超声检测
辨证分型
Knee osteoarthritis
Ultrasonic testing
TCM syndrome differentiation
