| 重度膝骨关节炎与骨髓水肿相关性研究 |
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Received:September 11, 2022
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| 作者 | Author | 单位 | Unit | E-Mail |
| 肖龙文 |
XIAO Long-Wen |
北京市丰盛中医骨伤专科医院, 北京 100033
中国中医科学院望京医院骨关节二科, 北京 100102 |
Beijing Fengsheng Special Hospital of Traditional Medical Traumatology and Orthopedics, Beijing 100033, China
The Second Department of Orthopadics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 桑志成 |
SANG Zhi-Cheng |
中国中医科学院望京医院骨关节二科, 北京 100102 |
The Second Department of Orthopadics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China |
sangzhch@126.com |
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| 期刊信息：《中国骨伤》2023年36卷，第6期，第525-531页 |
| DOI：10.12200/j.issn.1003-0034.2023.06.006 |
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目的：探讨骨髓水肿与重度膝骨关节炎病理改变及症状体征的关系。
方法：自2020年1月至2021年3月于中国中医科学院望京医院骨关节科就诊已行膝关节MRI检查的重度膝骨关节炎患者160例。合并骨髓水肿患者80例为病例组，男12例，女68例，年龄51~80（66.58±8.10）岁，病程5~40（15.61±9.25）个月，身体质量指数（body mass index，BMI）21.81~34.70（27.79±3.00） kg·m-2；不合并骨髓水肿的患者80例为对照组，男15例，女65例，年龄50~80（67.82±8.05）岁，病程6~37（15.75±8.18）个月，BMI 21.39~34.46（28.26±3.13） kg·m-2。采用膝关节整体磁共振成像评分（whole oragan magnetic resonance imaging score，WORMS）评价骨髓水肿程度，采用Kellgren-Lawrence （K-L）等级、Western Outario and McMaster大学骨关节炎指数评分（Western Ontario and McMaster University osteoarthritis index，WOMAC）评价膝骨关节炎病变程度，采用视觉模拟评分（visual analogue scale，VAS），WOMAC疼痛评分评价关节疼痛程度，采用压痛、叩击痛、关节肿胀度、关节活动度评分评价关节体征。比较两组患者K-L等级分布的差异探讨骨髓水肿与膝骨关节炎病变程度的关系；并进一步通过Spearman相关性分析病例组患者骨髓水肿WORMS评分与WOMAC指数、疼痛相关评分、体征相关评分的相关系数，以进一步探讨骨髓水肿与膝骨关节炎指数、关节疼痛症状、体征的关系。
结果：病例组患者K-L等级Ⅳ级者占68.75%（55/80），对照组患者等级Ⅳ级者占52.50%（42/80），病例组中Ⅳ级患者所占比例高于对照组（χ2=4.425，P<0.05）。病例组患者骨髓水肿WORMS与膝骨关节炎WOMAC指数相关系数为强正相关（r=0.873>0.8，P<0.001），骨髓水肿WORMS与VAS相关系数r=0.752>0.5，与WOMAC量表疼痛评分相关系数r=0.650>0.5，为中度相关（P<0.001）；骨髓水肿WORMS与叩击痛评分相关系数r=0.784>0.5，（P<0.001），为中度相关（P<0.05）；骨髓水肿WORMS评分与压痛评分相关系数r=0.194<0.3、关节肿胀度评分相关系数r=0.259<0.3、关节活动度评分相关系数r=0.296<0.3，相关性极弱（P<0.05）。
结论：膝骨关节炎病变越严重越容易引起骨髓水肿，同时骨髓水肿亦可加重膝骨关节炎病情；骨髓水肿可导致膝骨关节炎关节疼痛，叩击痛阳性体征，而压痛、关节肿胀、活动受限与骨髓水肿无明显相关。 |
| [关键词]:骨髓水肿 疼痛 体征 膝骨关节炎 相关性研究 |
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| Study on the relationship between severe knee osteoarthritis and bone marrow edema |
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Abstract:
Objective To investigate the relationship between bone marrow edema and pathological changes, symptoms and signs of severe knee osteoarthritis.
Methods From January 2020 to March 2021, 160 patients with severe knee osteoarthritis who underwrent MRI of the knee at the Department of Bone and Joint, Wangjing Hospital, China Academy of Chinese Medical Sciences were included. Eighty patients with bone marrow edema were selected as the case group, including 12 males and 68 females, aged from 51 to 80 years old with an average of (66.58±8.10) years old, the duration of disease 5 to 40 months with an average of (15.61±9.25) months. Eighty patients without bone marrow edema were selected as the control group, including 15 males and 65 females, aged from 50 to 80 years old with an average of (67.82±8.05) years old, the duration of disease 6 to 37 months with an average of (15.75±8.18) months, BMI was (28.26±3.13) kg·m-2 ranged from 21.39 to 34.46 kg·m-2. The degree of bone marrow edema was evaluated by knee whole oragan magnetic resonance imaging score (WORMS). The degree of knee osteoarthritis was evaluated by Kellgren- Lawrence(K-L) grade and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). The degree of joint pain was evaluated by visual analogue scale(VAS) and WOMAC pain score, the joint signs were evaluated by tenderness, percussion pain, joint swelling and joint range of motion. To explore the relationship between bone marrow edema and knee osteoarthritis, the prevalence of bone marrow edema and K-L grade were compared between the two groups. Furthermore the WORMS score and WOMAC index, pain-related score, and sign-related score correlation coefficient were analyzed to further explore the relationship between bone marrow edema and knee osteoarthritis index, joint pain symptoms and signs.
Results There was 68.75% (55/80) of the patients in the case group were in K-L grade Ⅳ, and 52.5% (42/80) in the control group, indicating a higher proportion of patients with grade Ⅳ in the case group than the control group (χ2=4.425, P<0.05). In the case group, there was a strong correlation between bone marrow edema WORMS score and knee osteoarthritis WOMAC index. (r=0.873>0.8, P<0.001), a moderate correlation between WORMS score and VAS score and WOMAC pain score(r=0.752, 0.650>0.5, P<0.001), a moderate correlation between WORMS score and percussion pain score (r=0.784>0.5, P<0.001), and a weak correlation between WORMS score and VAS and tenderness score, joint swelling score and joint range of motion score (r=0.194, 0.259, 0.296<0.3, P<0.001).
Conclusion Our study suggests that severe knee osteoarthritis is associated with an increased risk of bone marrow edema. Bone marrow edema can also lead to knee osteoarthritis joint pain, with percussion pain being a positive sign, but tenderness, joint swelling and limitation of activity are not significantly related to bone marrow edema. |
| KEYWORDS:Bone marrow edema Pain Physical signs Knee osteoarthritis Correlation study |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 肖龙文,桑志成.重度膝骨关节炎与骨髓水肿相关性研究[J].中国骨伤,2023,36(6):525~531 |
| 英文格式: | XIAO Long-Wen,SANG Zhi-Cheng.Study on the relationship between severe knee osteoarthritis and bone marrow edema[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(6):525~531 |
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