晚期膝骨关节炎的滑膜炎MRI厚度分级与滑膜病理相关性

doi:10.3877/cma.j.issn.1674-134X.2018.05.010

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 653 -661. doi: 10.3877/cma.j.issn.1674-134X.2018.05.010

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晚期膝骨关节炎的滑膜炎MRI厚度分级与滑膜病理相关性

陈宁杰¹, 赵卉¹, 郝风云², 刘浩³^,^†(

)

^1. 255000　淄博，滨州医学院附属淄博市中心医院骨科
^2. 266000　青岛大学医学院附属西海岸医院病理科
^3. 255000　淄博，滨州医学院附属淄博市中心医院医学影像科

收稿日期:2018-04-22 出版日期:2018-10-01
通信作者: 刘浩
基金资助:
山东省医药卫生科技发展计划项目(2015ws0004)

Correlation between grading of MRI-determined thickness and pathological scores of synovital membrane of synovitis in end-stage osteoarthritis

Ningjie Chen¹, Hui Zhao¹, Fengyun Hao², Hao Liu³^,^†()

^1. Department of Orthopaedics, Zibo Central Hospital, Binzhou Medical College, Zibo 255000, China
^2. Department of Pathology, West Coast Hospital , Qingdao University Medical College, Qingdao 266000, China
^3. Department of Radiology, Zibo Central Hospital, Binzhou Medical College, Zibo 255000, China

Received:2018-04-22 Published:2018-10-01
Corresponding author: Hao Liu
About author:
Corresponding author: Liu Hao, Email: 2055412472@qq.com

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引用本文：

陈宁杰, 赵卉, 郝风云, 刘浩. 晚期膝骨关节炎的滑膜炎MRI厚度分级与滑膜病理相关性[J]. 中华关节外科杂志(电子版), 2018, 12(05): 653-661.

Ningjie Chen, Hui Zhao, Fengyun Hao, Hao Liu. Correlation between grading of MRI-determined thickness and pathological scores of synovital membrane of synovitis in end-stage osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(05): 653-661.

目的

滑膜炎在膝骨关节炎(OA)中常见，晚期膝OA患者MRI测定的滑膜厚度分级与滑膜病理评分间的关系，尚不明确。本研究目的是探讨晚期膝OA患者中二者间关系，从而明确滑膜炎的MRI厚度分级和病理评分，是否可应用于OA的治疗效果评价。

方法

本次研究选择符合晚期膝OA诊断标准Ahlback分级法中的4级和5级并排除其他疾病的住院手术患者31例，均接受：①MRI对内、外侧间沟和内、外侧髌上囊4个区域滑膜的厚度进行分级测定，根据厚度将滑膜炎程度分为0～3级；②观察部位滑膜的取样进行苏木素－伊红(HE)染色、病理学评分；③采用Pearson线性相关或Spearman秩相关分析滑膜厚度分级、病理评分间的相关性，以相关系数(rs)评价。

结果

晚期膝OA 4个观察部位滑膜的MRI厚度分级差异无统计学意义(F＝0.39，P>0.05)；4个观察部位滑膜的病理评分和病理指标差异无统计学意义(F ＝2.146，P >0.05)；晚期膝OA滑膜炎的MRI厚度分级与病理评分具有正相关(rs ＝0.81、0.56、0.59和0.52，P <0.01)；与病理学3项指标具有正相关(rs＝0.4、0.47、0.36，P <0.05)。

结论

滑膜的MRI检查与滑膜病理具有较强相关性，因此滑膜MRI与病理检查可用于对滑膜炎敏感的OA治疗药物选择及晚期患者的治疗效果评价。

关键词: 骨关节炎, 磁共振成像, 滑膜, 病理学

Objective

To further investigate if MRI findings or the microscopic characteristics of synovitis could be used as criteria for the indications of knee replacement.

Methods

Thirty-one patients with end-stage knee osteoarthritis (OA) who met the fourth and fifth grade of the Ahlback classification and excluded other diseases were selected and received the following examinations: (1) noninvasive MRI evaluation for grading the synovial thickness of the investigated sites (i.e., medial and lateral parapatellar recesses, and medial and lateral suprapatellar pouches; synovitis was categorized into grade 0~3 on the basis of the thickness); (2) hematoxylin and eosin (HE) staining and pathological score grading of samples from the synovial membrane at each observed site; (3) Pearson’s linear test or Spearman rank test which was expressed as Spearman rank correlation (rs) was used to analyze the correlation between synovial thickness and pathological scores.

Results

Statistical analysis revealed no significant difference in MRI synovial thickness grade across the different regions of the knee. The mean pathological scores of the different regions showed no significant differences, neither did the mean pathological parameter scores (F=2.146, P>0.05). The grade of MRI-determined thickness of synovitis in patients with end-stage knee OA was positively correlated with the pathological scores (rs=0.81, 0.56, 0.59, 0.52 respectively; P <0.01) and the three pathological parameters (rs=0.4, 0.47, 0.36; P <0.05).

Conclusion

There is positively correlation between the grades of MRI-determined thickness and pathological scores of synovial membrane in patients with end-stage knee OA combining synovitis, which can be used as drug selection reference of synovitis-sensitive OA patients and the criteria of therapeutic efficacy for knee joint replacement.

Key words: Osteoarthritis, Magnetic resonance imaging, Synovial membrane, Pathology

图1 膝关节MRI像上4个观察部位滑膜厚度的测量。图A为膝关节MRI冠状位像，上箭头表示髌上囊及关节间沟；图B为膝关节MRI轴位像，上箭头表示测量内外侧髌上囊滑膜厚度；图C为膝关节MRI轴位像，上箭头表示测量膝关节内外侧间沟滑膜厚度

图2 Ostergaard滑膜厚度评级。图A为0级；图B为1级；图C为2级；图D为3级

图3 各观察部位间滑膜厚度形态分布图

表1 各观察部位间滑膜厚度评级与病理评分比较[n＝31，(±s)]

部位	厚度评级	病理评分
外侧间沟	1.7±1.0	5.1±2.3
外侧髌上囊	1.8±0.9	5.3±2.2
内侧间沟	1.7±0.9	4.5±2.3
内侧髌上囊	1.9±0.8	5.8±1.9
F值	0.39	1.71
P值	>0.05	>0.05

表1 各观察部位间滑膜厚度评级与病理评分比较[n＝31，(±s)]

部位	厚度评级	病理评分
外侧间沟	1.7±1.0	5.1±2.3
外侧髌上囊	1.8±0.9	5.3±2.2
内侧间沟	1.7±0.9	4.5±2.3
内侧髌上囊	1.9±0.8	5.8±1.9
F值	0.39	1.71
P值	>0.05	>0.05

图4 滑膜炎症病理(苏木精－伊红染色，×200)

图5 各观察部位间病理评分形态分布图

图6 观察部位平均病理指标评分形态分布图

图7 各部位滑膜厚度评级与病理评分相关性散点图。图A为外侧间沟厚度；图B为外侧髌上囊厚度；图C为内侧间沟厚度；图D为内侧髌上囊厚度

图8 各部位滑膜厚度与病理相关性形态分布图。图A为外侧间沟；图B为外侧髌上囊；图C为内侧间沟；图D为内侧髌上囊

表2 各部位滑膜厚度评级与病理评分相关性[n＝31，(±s)]

相关	外侧间沟	外侧髌上囊	内侧间沟	内侧髌上囊
rs	0.81	0.56	0.59	0.52
P值	<0.01	<0.01	<0.01	<0.01

表2 各部位滑膜厚度评级与病理评分相关性[n＝31，(±s)]

相关	外侧间沟	外侧髌上囊	内侧间沟	内侧髌上囊
rs	0.81	0.56	0.59	0.52
P值	<0.01	<0.01	<0.01	<0.01

图9 滑膜厚度与病理指标相关性散点图。图A为滑膜衬里层增生程度；图B为血管生成程度；图C为衬里下层炎症程度

表3 滑膜厚度评级与病理指标间相关性

厚度与病理指标	滑膜衬里层增生程度	衬里下层炎症程度	血管生成程度
rs	0.4	0.47	0.36
P值	0.026	0.008	0.045

表3 滑膜厚度评级与病理指标间相关性

厚度与病理指标	滑膜衬里层增生程度	衬里下层炎症程度	血管生成程度
rs	0.4	0.47	0.36
P值	0.026	0.008	0.045

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