膝關節滑膜結核20例的超聲表現及臨床分析

[摘要] 目的 探討膝關節滑膜結核的聲像圖特征，提高超聲診斷率。方法 對20例膝關節滑膜結核的超聲特征進行回顧性分析，結合臨床資料，找出規律。結果 20例膝關節滑膜結核的超聲表現:①20例膝關節腔內出現不同程度積液和滑膜增厚，占100%。②9例膝關節周圍出現不均質低回聲或混合性腫塊，占45%。③彩色多普勒檢查:病灶內部無明顯血流信號或顯示率極低。④12例出現同側腹股溝淋巴結腫大，占60%。結論 高頻超聲檢查膝關節滑膜結核有特征性的聲像圖表現，結合臨床與化膿性關節炎的慢性期、色素沉著絨毛結節性滑膜炎、類風濕關節炎等有鑒別意義，可初步作出診斷。

[關鍵詞] 高頻超聲;膝關節滑膜結核;寒性膿腫

[中圖分類號] R529.2[文獻標識碼] A [文章編號] 1004-8650(2009)07-04-03

The Ultrasonic Images and Clinical Expression of 20 cases of synovial tuberculosis of the knee

YANG Liu，CHEN Cai，CHEN Jian-jun

(Department of Echocardiography，Guigang City traditional Chinese and western medicine orthopedic hospital，Guangxi Guigang 537100 China)

[Abstract] Objective To evaluate the special images in high frequency ultrasound diagnosis for synovial tuberculosis of the knee. Enhances the ultrasound diagnosis rate.Methods The clinical data and sonographic features of 20 cases of with synovial tuberculosis of the knee were retrospectively analyzed and other clinical characteristics to find the potential rules. Results Effusion in varying degrees and synovial incrassation were showed on 20 patients' knee cavum articulare.The asymmetric hypoechoic lump or blended lump comes to light around 9 patients'knee joint. Color Doppler can't find patent blood stream signal when checking focal zone. Lymphadenectasis was showed on the sameside of12 patients' medial surface of thigh and groin.Conclusion High frequency ultrasound has the characteristic value acoustic image chart performance in the diagnosis of synovial tuberculosis the knee. Unifies clinically with the suppurative arthritis chronic， the pigmentation down nodular synovitis， kind of rheumatism arthritis and so on has the distinction significance， may make the diagnosis initially.

[Key words] high frequency ultrasound;synovial tuberculosis of the knee;cold abscess

膝關節結核在四肢關節結核中占首位，膝關節滑膜最豐富，因此滑膜結核最常見，如能早期診斷并積極治療，可避免發展成全關節結核。如果沒有骨質破壞，X線檢查容易漏診。為此，我科收集本院2003年1月-2008年12月20例經手術后病理證實為膝關節滑膜結核的聲像圖資料進行回顧性分析，結合臨床表現尋找規律，認為超聲在診斷膝關節滑膜結核方面具有優勢。現報告如下:

1資料與方法

1.1研究對象

20例膝關節滑膜結核均由手術病理證實。女性患者6 例，男性患者14例，年齡2-76歲，平均51歲。累及單側膝關節17例(左側9例，右側8例)，累及雙側膝關節3例。臨床表現:發現膝關節腫塊、關節疼痛1個月-3年，有乏力、消瘦，病變部位有輕度壓痛，關節活動受限。……