【摘要】 [目的]观察类风湿性关节炎足部病变的影像学表现,分析足部病变与类风关病程、中后足病变和前足部畸形的关系。[方法]类风关组56例112足,非类风关组52例10足,进行负重位的足部正侧位摄片,测量外翻角、第1、2跖骨夹角、内弓顶角、前弓角、距骨相对高度,单因素方差分析比较两组间的差异,控制年龄的偏相关分析研究类风关组中足部测量数据与病程、前足数据与中后足数据间的相关性。[结果]类风关组的外翻角、第1、2跖骨夹角、内弓顶角大于非类风关组,差异有显著性(P<0.05),距骨相对高度小于对照组,差异有显著性(P<0.05),内弓顶角与类风关病程呈正相关(P<0.01),距骨相对高度、前弓角与病程呈负相关(P<0.01),外翻角、第1、2跖骨夹角与病程无明显相关性,随着内弓顶角的增加和距骨相对高度的减小,外翻角增大(P<0.01)。[结论]类风关可造成严重的足部畸形,前足畸形在类风关早期即可出现,而中后足畸形出现相对较晚,但中后足畸形的出现将加剧前足畸形的程度,因此对于中后足部病变必须重视早期干预。更多还原

【Abstract】 [Objective]To study the foot radiographs of rheumatoid arthritis(RA),evaluate the relationship between foot deformity and disease duration,the relationship between flat foot and forefoot deformities in RA,thus to improve understanding of the progression of deformity and provide more appropriate treatment. [Method]Anteroposterior and lateral weight-bearing radiographs were obtained for 112 feet of patients with RA and 104 feet of patients without RA.The hallux valgus angle,the first intermetatarsals angle,the top angle of the medial longitudinal arch,the anterior angle of the medial longitudinal arch,the relative height of the talus were measured.One-Way ANOVA were used to evaluate the difference between two groups,and partial correlations were used to analyze the relationship between the foot deformities and disease duration by control the age,the relationship between flat foot and forefoot deformity by control the age was also analyzed.[Result]The hallux valgus angle was 24.2±14.3 in RA group and 13.2±5.3 in control group,the first intermetatarsals angle was 9.6±5.9 in RA group and was 7.6±4.4 in control group,the top angle of the medial longitudinal arch was 129.4±6.6 in RA group and 124.4±5.2 in control group,the anterior angle of the medial longitudinal arch was14.5±3.0 in RA group and 16.2±4.5 in control group,the relative height of the talus was 0.184±0.024 in RA group and was 0.191±0.032 in control group,there was significant difference between two groups except the anterior angle of the medial longitudinal arch.With the increase of disease duration,the top angle of the medial longitudinal arch,increased in RA group(P<0.05),and the antrior angle of the medial longitudinal arch,the relative height of the talus became small(P<0.05).The hallux valgus angle and the first intermetatarsals angle increased with the increasing of the top angle of the medial longitudinal arch(P<0.01),and the decrease of the relative height of the talus(P<0.01).[Conclusion]Foot deformities are common in RA,mid-rearfoot deformity increases with disease duration,as this not happened in forefoot,but the flat foot deformity will exacerbate the forefoot deformity,so proper medical treatment must beused in early stage of the mid-rearfoot involvement to avoid progressive serious foot disfunction.更多还原