Clinical characteristics and related factors of elbow joint disease in skeletal fluorosis
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目的 探讨地方性氟骨症患者肘关节常见临床表现的分布特征及其与影响因素的相关性.方法 将甘肃省饮水型地方性氟中毒病区县高台县、皋兰县的13个病区村作为样本村,对该村全部常住成年居民开展横断面调查,调查内容:①人口学信息、家族史、现病史调查;②骨科临床专科查体;③前臂(含肘关节)和小腿(含膝关节)数字X线摄影拍片,并根据X线表现划分肘关节Kellgkn-Lawrence分级(K-L分级);④身高、体质量检测,并计算体质指数(BMI);⑤应用Mayo肘关节评分量表评价肘关节功能.根据调查结果描述氟骨症患者肘关节临床症状和体征的分布特征,以及患者年龄、性别、病程、BMI、K-L分级等肘关节功能影响因素的分布特征及其相关性.计数资料和率的比较采用x2检验或Fisher精确概率法,符合正态分布的连续资料的相关性分析用Pearson检验,非正态分布的计量和计数资料用Spearman检验.有序等级资料的相关性分析用Kendall's Tau-b检验.结果 ①在501例氟骨症患者中,共检出肘关节疼痛患者465例(92.8％)、肘关节有压痛者185例(36.9％)、肘关节肿大者300例(59.9％)、肘关节晨僵者415例(82.8％)、肘管综合征阳性者102例(20.4％)、前臂伸肌腱牵拉试验阳性153例(30.5％)、前臂屈肌腱牵拉试验阳性97例(19.4％);肘关节旋转受限以关节活动范围(ROM)在30°～70°者检出率最高(261例,52.1％),肘关节伸屈受限以ROM在50°～90°者检出率最高(274例,54.7％).②在501例氟骨症患者中,共检出肘关节有症状和阳性体征者465例,其中男性检出率＜女性,差异有统计学意义(x2=41.19,P＜0.001).年龄以50～65岁者最多(274/501,58.9％),体质指数以BMI＜18 kg/m2者最多(217/501,46.7％),K-L关节炎放射学分级以Ⅲ级者最多(256/501,55.0％),病程以＞30年者最多(217/501,46.7％).③氟骨症临床特征、Mayo评分与各影响因素的相关性:疼痛与年龄(r=0.79,P＜0.001)、疼痛与病程(r=0.71,P＜0.001)有较高相关性;伸屈 ROM 与年龄(r=-0.43,P＜0.001)、伸屈 ROM 与 K-L 分级(r=-0.67,P＜0.001)、伸屈 ROM与病程(r=-0.48,P＜0.001)均呈负相关;肘管综合征与年龄(r=0.72,P＜0.001)呈正相关;Mayo功能评分与年龄(r=-0.35,P＜0.001)呈负相关.结论 肘关节晨僵(＜30 min)、肘关节旋转受限、肘关节伸屈受限、肘管综合征(Ⅰ度)在氟骨症人群中有较高的检出率;年龄、病程、关节退变程度对氟骨症肘关节功能有较大影响.
Objective To explore the distribution characteristics of common clinical manifestations of elbow joint in patients with endemic fluorosis and their correlation with the influencing factors.Methods A cross-sectional survey was conducted on all permanent adult residents in 13 endemic fluorosis villages in Gaotai and Gaolan counties of Gansu province.The survey included:① Demographic information,family history,and current medical history.② Physical examination specifically focued on the orthopedic clinical presentations.③Taking DR films of the forearm(including elbow joint)and calf(including knee joint),and classify the elbow joint to grade K-L based on X-ray manifestations.④ Measuring height and weight,and calculating BMI index.⑤Applying the Mayo elbow joint rating scale to evaluate elbow joint function.Based on the survey results,the distribution characteristics of clinical symptoms and signs of elbow joint in patients with skeletal fluorosis,as well as the distribution characteristics and correlation of factors affecting elbow joint function such as age,gender,disease course,BMI,K-L grade,etc were described.The comparison of counting data and rates were analyzed with x2 test or Fisher exact probability test.Pearson's test was used for correlation analysis of continuous data that conforms to normal distribution,and Spearman test was used for non-normal distribution measurement and counting data.The correlation analysis of ordered hierarchical data was conducted using Kendall's Tau-b test.Results ①Among 501 patients with skeletal fluorosis,a total of 465 cases(92.8％)were diagnosed with elbow joint pain.A total of 185 cases(36.9％)were with elbow joint tenderness,300 cases(59.9％)were with elbow joint enlargement,415 cases(82.8％)were with morning stiffness of the elbow joint,102 cases(20.4％)were with cubital tunnel syndrome,153 cases(30.5％)were with positive forearm extensor tendon traction test,and 97 cases(19.4％)were with positive forearm flexor tendon traction test.The detection rate of elbow joint rotation limitation was the highest among those with ROM ranging from 30 ° to 70 °(261/501,52.1％),and the detection rate of elbow joint extension and flexion limitation was the highest among those with ROM ranging from 50 ° to 90 °(274/501,54.7％).②Among 501 patients with skeletal fluorosis,a total of 465 cases were found to have symptoms and positive signs in the elbow joint,with the detection rate in males being lower than that in females,with a significant difference(x2=41.19,P＜0.001).The majority of patients were between the ages of 50 and 65(274/501,58.9％),with a body mass index of＜18(217,46.67％),K-L arthritis with a radiologic grade of Ⅲ(256/501,55.0％),and a disease course of＞30 years(217/501,46.67％).③The correlation between clinical characteristics,the Mayo score,and various influencing factors of skeletal fluorosis found a high correlation between pain and age(r=0.79,P＜0.001)and pain and disease course(r=0.71,P＜0.001).The ROM of extension and flexion was negatively correlated with age(r=-0.43,P＜0.001),K-L grade(r=-0.67,P＜0.001),and disease course(r=-0.48,P＜0.001);Elbow tunnel syndrome was positively correlated with age(r=0.72,P＜0.001).The Mayo functional score was negatively correlated with age(r=-0.35,P＜0.001).Conclusion Early morning stiffness of the elbow joint(＜30 min),limited rotation of the elbow joint,limited extension and flexion of the elbow joint,and cubital tunnel syndrome(degree Ⅰ)have a high detection rate in the population with skeletal fluorosis.Age,course of disease,and degree of joint degeneration have a significant impact on elbow joint function in patients with fluorosis.
NETL
NSTL
万方数据
