■骨髓病变(BMLs)是骨关节炎患者磁共振成像(MRI)发现的常见软骨下缺损,常伴有疼痛和功能限制。软骨下成形术(SCP)是一种相对较新的技术,其中将骨替代材料(BSM)注射到BML区域内,为软骨下骨提供结构支撑。防止其崩溃和减少疼痛。
■这项研究的目的是表征疼痛的变化,功能和放射学结果,转换为膝关节置换,和SCP后的并发症。我们假设在SCP后6个月的随访中,≥70%的患者在数字评定量表(NRS)上的疼痛减轻≥4分。
■案例系列;证据级别,4.
■接受SCP治疗的有症状的膝关节BMLs患者在术前和术后1、6、12和24个月进行前瞻性评估。使用NRS测量疼痛的功能结果,膝关节社会评分(KSS),西安大略省和麦克马斯特大学骨关节炎指数(WOMAC),和国际膝关节文献委员会(IKDC)评分。术前以及随访6个月和12个月时进行X线片和MRI检查,以验证水肿的愈合和骨骼结构的变化。
■总共50名患者被纳入研究。平均随访26个月(24~30个月)。与术前值比较,每个随访点的平均NRS评分均下降(所有P<0.0001),IKDC,WOMAC,在6个月和12个月的随访中,KSS评分显着改善。术后6个月,27名患者(54%)的NRS降低≥4分。术后MRI显示在注射部位被高强度信号包围的低信号区。标准射线照相显示4例(8%)患者的骨关节炎等级恶化。11例患者进行了膝关节置换,其中7例患者由于致残症状的恶化或持续,而4例患者由于骨关节炎的进展而进行了膝关节置换。在研究期间,有6例患者发生了BSM泄漏,没有任何临床后果。
■大约一半的研究患者在SCP后6个月的随访中NRS降低了4分。
■NCT04905394(ClinicalTrials.gov标识符)。
UNASSIGNED: Bone marrow lesions (BMLs) are common subchondral defects revealed by magnetic resonance imaging (MRI) in patients with osteoarthritis, often associated with pain and functional limitation.
Subchondroplasty (SCP) is a relatively new technique in which bone substitute material (BSM) is injected inside BML areas to provide structural support to the subchondral bone, preventing its collapse and reducing pain.
UNASSIGNED: The purpose of this study was to characterize changes in pain, functional and radiological outcomes, conversion to knee replacement, and complications after SCP. We hypothesized that ≥70% of patients would achieve a reduction in pain of ≥4 points on a numeric rating scale (NRS) at a 6-month follow-up after SCP.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: Patients with symptomatic knee BMLs who underwent SCP were prospectively evaluated preoperatively and at 1, 6, 12, and 24 months postoperatively. Functional outcomes were measured with the NRS for pain, Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC) scores. Radiographs and MRI were performed preoperatively and at 6- and 12-month follow-ups to verify edema healing and changes in bone structure.
UNASSIGNED: A total of 50 patients were included in the study. The mean follow-up was 26 months (24-30 months). Compared with preoperative values, the mean NRS score decreased at every follow-up point (P < .0001 for all) and the IKDC, WOMAC, and KSS scores improved significantly at 6- and 12-month follow-ups. At 6 months postoperatively, 27 patients (54%) registered a reduction on the NRS of ≥4 points. Postoperative MRI revealed a hypointense zone surrounded by a hyperintense signal at the injection site. Standard radiography showed osteoarthritis grade worsening in 4 (8%) patients. Knee replacement was performed in 11 patients -in 7 patients due to the worsening or persistence of disabling symptoms and in 4 patients due to the progression of osteoarthritis. The leakage of BSM occurred in 6 patients without any clinical consequences during the study period.
UNASSIGNED: About half of the study patients achieved a reduction in the NRS of 4 points at the 6-month follow-up after SCP.
UNASSIGNED: NCT04905394 (ClinicalTrials.gov identifier).