骨骼肌肉超音波－風濕科醫師擴展理學檢查能力之手

Musculoskeletal Ultrasound in Rheumatic Diseases-The Extended Physical Examination Hands of Rheumatologist

邱啓勝(Chi-Sheng Chiou) ； 張棋楨(Chi-Ching Chang) ； 廖學聰(Say-Tsung Liao)

《內科學誌》 21卷1期 (2010/02) Pp. 6-11

https://doi.org/10.6314/JIMT.2010.21(1).02

摘要

在內科系中，超音波對心臟科及腸胃科之重要性是無庸置疑的，近二十年來骨骼肌肉超音波（musculoskeletal ultrasound，骨超）的長足發展進步及實證醫學的證據，已充分顯示骨超擴展了風濕科醫師的臨床診斷能力和提昇介入性檢查與治療的技術。骨超診斷和定位關節或滑囊積水及滑膜炎優於臨床的理學檢查。診斷肌腱病變之首選影像是骨超。骨超偵測類風濕性關節炎的骨頭侵蝕其敏感性比X光高，亦可監測類風濕性關節炎的進展。舉凡肌肉、韌帶、周邊神經、軟骨等組織病變亦能由骨超檢查出來。此外骨超還能幫忙診斷皮肌炎、血管炎及修格蘭氏症候群。骨超指引抽取關節液及關節內注射可提高準確率，進而改善治療效果。骨超已成爲最常用來評估病人之關節炎及局部疼痛的工具。本文乃回顧及闡述目前骨超在風濕疾病(rheumatic disease)的應用。

關鍵字

骨骼肌肉超音波 ； 風濕科醫師 ； 風濕疾病

並列摘要

Musculoskeletal ultrasound (MSUS) allows high-resolution, real-time imaging of articular and periarticular structures and is routinely used by an increasing number of rheumatologists in rheumatological practice. There is now accumulating evidence that MSUS improves clinical diagnosis and intervention skills. MSUS is superior to clinical examination in the diagnosis and localization of joint and bursal effusion and synovitis. MSUS is the imaging modality of choice for the diagnosis of tendon pathology. MSUS is seven times more sensitive than plain radiography in the detection of rheumatoid erosions, allowing earlier diagnosis of progressive rheumatoid arthritis. Ligament, muscle, peripheral nerve and cartilage pathology can also be readily demonstrated by MSUS. There is exciting evidence that not only joint and muscle disease but also scleroderma, vasculitis and Sjögren's syndrome may be diagnosed by MSUS potentially. Joint aspiration and injection accuracy can be improved by MSUS, with initial evidence confirming improved efficacy. There is likely to be a growing number of proven clinical indications for the application of MSUS in rheumatology practice due to the increasing number of rheumatologists performing MSUS and the improving technical capabilities of MSUS. This paper reviews the evidence for the application of MSUS in rheumatologic diseases.

並列關鍵字

Musculoskeletal ultrasound ； Rheumatologist ； Rheumatic disease