目的:探讨骨髓水肿与病理变化的关系,严重膝骨关节炎的症状和体征。
方法:从2020年1月至2021年3月,160名严重的膝骨关节炎患者在骨与关节部接受膝关节MRI检查,望京医院,中国中医科学院入选。选取80例骨髓水肿患者作为病例组,包括12名男性和68名女性,年龄在51至80岁之间,平均(66.58±8.10)岁,病程5~40个月,平均(15.61±9.25)个月。选取80例无骨髓水肿的患者作为对照组,包括15名男性和65名女性,年龄在50至80岁之间,平均(67.82±8.05)岁,病程6~37个月,平均(15.75±8.18)个月,BMI为(28.26±3.13)kg·m-2,范围为21.39~34.46kg·m-2。采用膝关节全oragan磁共振评分(WORMS)评价骨髓水肿程度。膝关节骨性关节炎的程度通过Kellgren-Lawrence(K-L)分级和西安大略和麦克马斯特大学骨关节炎指数(WOMAC)进行评估。疼痛程度采用视觉模拟评分法(VAS)和WOMAC疼痛评分,通过压痛评估关节体征,打击乐疼痛,关节肿胀和关节活动范围。探讨骨髓水肿与膝骨关节炎的关系,比较两组骨髓水肿发生率和K-L分级。此外,WORMS得分和WOMAC指数,疼痛相关评分,和体征相关评分相关系数分析,进一步探讨骨髓水肿与膝骨关节炎指数的关系,关节疼痛的症状和体征。
结果:病例组中68.75%(55/80)的患者为K-LⅣ级,对照组为52.5%(42/80),病例组Ⅳ级患者比例高于对照组(χ2=4.425,P<0.05)。在案例组中,骨髓水肿WORMS评分与膝骨关节炎WOMAC指数有很强的相关性。(r=0.873>0.8,P<0.001),WORMS评分与VAS评分及WOMAC疼痛评分呈中度相关(r=0.752,0.650>0.5,P<0.001),WORMS评分与搏击疼痛评分呈中度相关(r=0.784>0.5,P<0.001),WORMS评分与VAS和压痛评分之间的相关性较弱,关节肿胀评分和关节活动范围评分(r=0.194、0.259、0.296<0.3,P<0.001)。
结论:我们的研究表明严重的膝骨关节炎与骨髓水肿的风险增加有关。骨髓水肿还会导致膝关节骨性关节炎关节疼痛,打击乐疼痛是一个积极的迹象,但温柔,关节肿胀和活动受限与骨髓水肿无关。
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).
CONCLUSIONS: 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.