目的证实大骨节病与饮茶型氟中毒重叠病区中存在大骨节病病例罹患氟骨症的特征性病例,为诊断、预防和控制同患此两种疾病提供科学依据。方法 (1)按大骨节病诊断标准进行临床和X线检查,筛选出大骨节病病例人群做为研究对象;(2)每个研究对象进行调查日饮茶量等信息并采集所饮砖茶水和尿液,用氟离子选择电极法测定茶水和尿氟含量,计算人群摄氟量、人群尿氟值,并就大骨节病病例罹患氟骨症人群(氟骨症人群组)与大骨节病病例未患氟骨症人群(大骨节病人群组)进行比较;(3)每个研究对象拍摄前臂(包括肘关节)X线片,按氟骨症X线诊断标准诊断氟骨症,并就氟骨症人群组与大骨节病人群组掌指、前臂的临床体征以及X线影像进行比较。结果 (1)40~78岁之间的自愿受试者共61人中确诊大骨节病病例45人,其中Ⅰ度病例检出34例、Ⅱ度病例检出5例、Ⅲ度病例检出6例;(2)45例大骨节病病例共确诊氟骨症19人,其中Ⅰ度病例检出4人、Ⅱ度病例检出2人、Ⅲ度病例检出13人;(3)氟骨症人群组摄氟量人均日为7.69 mg,是大骨节病人群组人均日摄氟量的2倍,也是人群总摄氟量卫生标准的2倍;氟骨症人群组尿氟含量几何均值为3.03 mg/L,是大骨节病人群组尿氟值的1.5倍,是人群尿氟正常值的2倍。(4)氟骨症人群组与大骨节病人群组掌指、前臂的临床体征以及X线影像进行比较,掌指临床体征及其X线影像基本无差异;氟骨症人群肘关节(被动)后伸10~70度的为84.21%(16/19),大骨节病人群组肘关节(被动)后伸10~30度的为30.77%(7/26),卡方检验,χ2=4.89>χ20.05(1)=3.84,P<0.05两者之间有显著统计学差异,并且,大骨节病人群组肘关节后伸曲度均在30度以内,而氟骨症人群组大于30度的达到56.25%(9/16);X线影像上大骨节病人群组除无桡尺骨间膜骨化外,表现为肘关节退变和骨质增生,而氟骨症人群组表现为肘关节退变、骨质增生并伴有膨大、变形以及肌腱韧带附着点和关节囊骨化。结论 (1)证实了大骨节病与饮茶型氟中毒重叠病区中存在大骨节病病例罹患氟骨症的特征性病例;(2)大骨节病发病在前,氟骨症发病在后;(3)掌指临床体征和X线影像基本无差异;(4)氟骨症人群组的肘关节损害体征重于大骨节病人群组,X线影像具有双重性。 Objective To confirm the characteristic cases of Kashin-Beck disease in patients with Kashin-Beck disease and tea-drinking fluorosis with overlapping fluorosis area, and to provide a scientific basis for the diagnosis, prevention and control of these two diseases. Methods (1) According to diagnostic criteria of KBD, clinical and X-ray examination were performed to screen out Kashin-Beck disease patients as subjects; (2) And urine, fluoride ion-selective electrode method for the determination of tea and urine fluoride content, calculate the amount of fluoride in the crowd, the crowd urine fluoride value, and patients with Kashin-Beck disease suffered from skeletal fluorosis (skeletal fluorosis group) and bones (3) Each subject photographed X-ray of forearm (including elbow joint), diagnosed skeletal fluorosis according to X-ray diagnostic criteria of skeletal fluorosis, and The skeletal fluorosis group and the group of patients with metacarpophalangeal finger forearm clinical signs and X-ray images were compared. Results (1) Forty-five cases of Kashin-Beck disease were diagnosed in 61 volunteers between 40 and 78 years old, of which 34 were detected in grade Ⅰ, 5 in grade Ⅱ and 6 in grade Ⅲ (2) A total of 19 cases of skeletal fluorosis were diagnosed in 45 cases of Kashin-Beck disease. Among them, 4 cases were detected in Ⅰ-degree cases, 2 cases in Ⅱ-degree cases and 13 cases in Ⅲ-degree cases. (3) Per capita daily intake of fluoride group was 7.69 mg, which was twice as high as per capita daily fluoride intake of Kashin-Beck disease group and twice as high as the health standard of total fluoride exposure. The geometric mean of urinary fluoride content in fluorosis group 3.03 mg / L, which is 1.5 times of urinary fluoride in patients with Kashin-Beck disease and twice as high as normal urinary fluoride in the population. (4) Compared with clinical manifestations and X-ray images of the metacarpophalangeal and forearm in skeletal fluorosis patients and those in the patients with Kashin-Beck disease, clinical signs and X-ray images of the fingers of the finger were almost the same. Elbow joints in the patients with skeletal fluorosis ) Was 84.21% (16/19) after 10 to 70 degrees of extension, 30.77% (7/26) after 10-30 degrees of elbow flexion (passive) in the KB group, Chi-square test, χ2 = 4.89 > χ20.05 (1) = 3.84, P <0.05 There was a significant difference between the two, and, Kashin-Beck elbow flexion group were within 30 degrees, while the skeletal fluorosis group was greater than 30 degrees to 56.25% (9/16); X-ray image of the group of patients with Kashin-Beck ulnar radial ossification, the performance of elbow degeneration and bone hyperplasia, and skeletal fluorosis group showed For the elbow degeneration, hyperosteogeny accompanied by enlargement, deformation, and tendon ligament attachment points and joint capsule ossification. Conclusions (1) Confirmed the characteristic cases of Kashin-Beck disease in patients with Kashin-Beck disease and tea drinking-type fluorosis overlapping wards; (2) The incidence of Kashin-Beck disease was before and the incidence of skeletal fluorosis was later; (3) There was almost no difference between the clinical signs and X-ray images of the metacarpophalangeal finger. (4) The signs of elbow injuries in the skeletal fluorosis group were heavier than those in the patients with KBD.