目的 探讨类风湿性关节炎(RA) 手腕关节病变的超声及影像学特点诊断价 值。方法 选取我院2016年2月至2018年6 月收治的RA伴手腕关节病变患者48例为研 究对象，采用超声诊断仪及CT扫描仪对其 腕关节、第1至第5掌指关节(MCP)、第2至 第5近端指间关节(PIP)进行检查，分析滑 膜厚度、关节腔积液及骨质破坏情况。结 果 48例患者共检查1206个关节，含110个 腕关节、548个MCP关节、548个PIP关节， 超声影像特点：①手腕部滑膜炎表现为 关节腔内低回声，无法被移位或压缩， 见血流信号，②手腕部关节积液在超声 下表现为关节间隙增加，呈带状、条状无 回声区，分布不均匀，可被移位或压缩， 无多普勒血流信号，③手腕部骨侵蚀在超 声下呈骨皮质连续性中断或“火山口样” 缺损、“虫蚀样”改变；CT可见骨质疏松 及关节间隙狭窄征象，右腕关节右舟骨与 桡骨远端关节面下明显的骨侵蚀改变；超 声对骨质侵蚀、腕关节早期病变的检出率 高于CT(P＜0.05)，而两种检查方法对滑 膜炎、关节腔积液、腱鞘炎的检出率比较 差异无统计学意义(P＞0.05)。结论 RA患 者手腕发生关节病变时，采用超声诊断可 检出滑膜厚度、关节腔积液及骨质破坏程 度，应用CT检查也有一定诊断价值，但在 评估骨质侵蚀方面不及超声诊断。

Objective To investigate the diagnostic value of ultrasonic and imaging features of (RA) wrist joint lesions in rheumatoid arthritis. Methods 48 patients with RA and wrist joint lesion in our hospital from February 2016 to June 2018 were selected in the study. The wrist, the first to fifth metacarpophalangeal joints (MCP) and the 2nd to 5th proximal interphalangeal joint (PIP) were examined with ultrasonic diagnostic instrument and CT scanner, the synovial thickness, joint cavity effusion and bone destruction were analyzed. Results 1206 joints were examined in 48 patients, including 110 wrist joints, 548 MCP joints, and 548 PIP joints. Ultrasound imaging features: 1. wrist synovitis showed low echo in the joint cavity, could not be displaced or compressed, there was blood flow signal. 2. wrist joint effusion under ultrasound showed joint space increase, banded shape, stripshaped anechoic area, uneven distribution, can be displaced or compressed, no Doppler blood flow signal. 3. wrist bone erosion under the ultrasound showed disruption of cortical bone continuity or "crater-like" defect, "worm-like" changed, the osteoporosis and joint space stenosis signs were visible by CT, there was significant bone erosion changes in the right wrist joint right scaphoid and distal radius joint surface; the detection rate of bone erosion and early wrist lesion by ultrasound was higher than that by CT (P<0.05). There was no significant difference in the detection rate of synovitis, joint effusion, tenosynovitis by the two methods (P>0.05). Conclusion When patients with RA appear arthropathy, the degree of synovial thickness, joint effusion and bone destruction can be detected by ultrasound diagnosis. The use of CT examination has certain diagnostic value, but it is not as good as ultrasound diagnosis in evaluating bone erosion.