1. 上海中医药大学附属曙光医院石氏伤科医学中心,上海,201203
2. 上海市中医药研究院骨伤科研究所,上海,201203
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杨光月, 郭海玲, 李涛, 等. 早期膝骨关节炎软骨下骨骨髓病变与软骨损伤的相关性研究[J]. 上海中医药杂志, 2020,54(12):10-14.
YANG Guangyue, GUO Hailing, LI Tao, et al. Correlation between subchondral bone marrow lesions and cartilage injuries in early knee osteoarthritis[J]. Shanghai Journal of Traditional Chinese Medicine, 2020,54(12):10-14.
杨光月, 郭海玲, 李涛, 等. 早期膝骨关节炎软骨下骨骨髓病变与软骨损伤的相关性研究[J]. 上海中医药杂志, 2020,54(12):10-14. DOI: 10.16305/j.1007-1334.2020.2001070.
YANG Guangyue, GUO Hailing, LI Tao, et al. Correlation between subchondral bone marrow lesions and cartilage injuries in early knee osteoarthritis[J]. Shanghai Journal of Traditional Chinese Medicine, 2020,54(12):10-14. DOI: 10.16305/j.1007-1334.2020.2001070.
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:①OA组中41.77%的患者K-L分级在Ⅰ级以内,58.20%为K-L Ⅱ级。两组体质量和BMI值差异无统计学意义(P>0.05)。②OA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. MethodsThe 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:①In 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). ②The T2 values of patellar cartilage and femoral cartilage in OA group were significantly higher than those in healthy group (P<0.05). ③Patients 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. ④WORMS 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.
膝骨关节炎磁共振软骨下骨骨髓病变软骨损伤全膝关节成像评分磁共振T2值测量及伪彩图
knee osteoarthritismagnetic resonanceBMLscartilage injuryWORMST2 mapping
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