摘要
目的探讨早期膝骨关节炎(OA)患者软骨下骨骨髓病变与相应区域关节软骨损伤的关系。方法对纳入研究的67名早期膝骨关节炎患者(OA组)及22名健康志愿者(健康组)的膝关节进行磁共振扫描,在磁共振T2值测量及伪彩图(T2 mapping)序列中测量不同分区膝关节软骨T2值;OA组应用全膝关节成像评分(whole organ magnetic resonance imaging score,WORMS)评价不同分区软骨下骨骨髓病变(bone marrow lesion,BMLs)。研究比较膝关节各分区软骨T2值之间的差异,并进行不同分区患者软骨T2值与相应区域的BMLs评分的相关性分析。结果 (1)OA组中41.77%的患者K-L分级在Ⅰ级以内,58.20%为K-LⅡ级。两组体质量和BMI值差异无统计学意义(P>0.05)。(2)OA组髌骨软骨T2值、股骨软骨T2值均明显高于健康组(P<0.05)。(3)早期膝骨关节炎患者都伴随有不同程度的软骨损伤和骨赘形成;软骨下骨骨髓病变及半月板损伤的发生率也很高,分别占86.4%和84.8%;提示早期膝骨关节炎的病理改变是包含软骨、软骨下骨、半月板等在内的全膝关节退变。(4)早期膝骨关节炎患者内外侧股骨髁,内外侧胫骨平台BMLs的WORMS评分均与相应区域软骨T2值呈正相关(P<0.05)。结论早期膝骨关节炎患者的股骨、髌骨软骨都有不同程度的退变;胫骨平台、股骨髁区域BMLs范围越大,相应区域的软骨损伤越严重。
Objective To investigate the relationship between subchondral bone marrow lesions and articular cartilage injuries in early knee osteoarthritis(OA) patients. Methods The knee joints of 67 patients with early knee osteoarthritis(OA group) and 22 healthy volunteers(healthy group) were enrolled for magnetic resonance imaging(MRI) scanning, and T2 values of knee cartilage in different regions were measured by T2 mapping sequence. In OA group, the whole organ magnetic resonance imaging score(WORMS) was used to evaluate the subchondral bone marrow lesions(BMLs) in different regions. The difference of cartilage T2 values in different regions was compared, and the correlation between cartilage T2 values in different regions and BMLs scores in corresponding regions was analyzed. Results(1)In OA group, 41.77% of the patients were within K-L grade I and 58.20% in K-L grade Ⅱ. There was no significant difference in body mass and BMI between the two groups(P>0.05).(2)The T2 values of patellar cartilage and femoral cartilage in OA group were significantly higher than those in healthy group( P<0.05).(3)Patients with early knee osteoarthritis were often accompanied by different degrees of cartilage injuries and osteophyte formation with high incidences of subchondral bone marrow lesions and meniscus injuries,accounting for 86.4% and 84.8% respectively. It is suggested that the pathological change of early knee osteoarthritis is the degeneration of total knee joints including cartilage,subchondral bone,and meniscus,etc.(4)WORMS scores of BMLs in medial and lateral femoral condyle and medial and lateral tibial plateau of patients with early knee osteoarthritis were positively correlated with T2 values of cartilage in corresponding regions( P<0.05). Conclusion Femoral and patellar cartilages of patients with early knee osteoarthritis have degeneration to varying degrees. The larger the BMLs range in tibial plateau and femoral condyle region,the more severe the cartilage injuries in the corresponding region.
作者
杨光月
郭海玲
李涛
商海滨
赵咏芳
YANG Guangyue;GUO Hailing;LI Tao;SHANG Haibin;ZHAO Yongfang(Shi’s Traumatology Medical Center,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Institute of Orthopaedics and Traumatology,Shanghai Academy of Traditional Chinese Medicine,Shanghai 201203,China)
出处
《上海中医药杂志》
2020年第12期10-14,44,共6页
Shanghai Journal of Traditional Chinese Medicine
基金
国家自然科学基金项目(81774342,81473703)
上海申康医院发展中心慢性病综合防治项目(SHDC12015316)
上海中医健康服务协同创新中心开放项目(ZYJKFW201811005)
国家科技部重大新药创制国家科技重大专项(2015ZX09101021)
上海市重中之重临床重点学科建设项目(2017ZZ02024)
上海市中医药新兴交叉学科“工效筋骨学”项目[沪卫计中发2017(024)号]
上海市科委科研计划项目(17401901900)
上海市卫计委进一步加快中医药事业发展三年行动计划项目[(2014年-2016年)(ZY3-CCCX-3-2008)]
上海市卫健委青年基金项目(20194Y0010)。
