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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (04) : 412 -418. doi: 10.3877/cma.j.issn.1674-134X.2019.04.005

所属专题： 文献；

临床论著

晚期膝骨关节炎滑膜MRI厚度与疼痛及功能评分相关性
陈宁杰1, 赵卉1, 郝风云2, 刘浩3,†()   
  1. 1. 255000　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　滨州医学院附属淄博市中心医院医学影像科
  • 收稿日期:2018-04-23 出版日期:2019-08-01
  • 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 of knee synovitis and knee joint function and pain scores in end-stage osteoarthritis

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

  1. 1. Department of Orthopaedics, Zibo Central Hospital Affiliated to Binzhou Medical College, Binzhou 255000, China
    2. Department of Pathology, West Coast Hospital, Qingdao University Medical College, Qingdao 266000, China
    3. Department of Radiology, Zibo Central Hospital Affiliated to Binzhou Medical College, Binzhou 255000, China
  • Received:2018-04-23 Published:2019-08-01
  • Corresponding author: Hao Liu
  • About author:
    Corresponding author: Liu Hao, Email:
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引用本文：

陈宁杰, 赵卉, 郝风云, 刘浩. 晚期膝骨关节炎滑膜MRI厚度与疼痛及功能评分相关性[J]. 中华关节外科杂志(电子版), 2019, 13(04): 412-418.

Ningjie Chen, Hui Zhao, Fengyun Hao, Hao Liu. Correlation between grading of MRI-determined thickness of knee synovitis and knee joint function and pain scores in end-stage osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(04): 412-418.

目的

探讨晚期膝骨关节炎(OA)患者中滑膜厚度分级与膝关节疼痛及功能评分间的关系，从而明确滑膜炎的MRI厚度分级是否可用于作为膝关节置换的适应证标准。

方法

选择晚期膝OA患者31例，接受：①MRI对膝内、外侧间沟和内、外侧髌上囊4个观察部位滑膜的厚度进行分级测定，根据厚度可将滑膜炎程度分为0～3级；②全膝关节置换(TKA)术前的膝关节疼痛评分(VAS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)。采用Pearson线性相关或Spearman秩相关分析滑膜厚度分级与WOMAC以及VAS之间的相关性。

结果

晚期膝OA 4个观察部位滑膜的MRI厚度分级无显著性差异，不同部位滑膜厚度与疼痛评分不具有相关性，不同部位滑膜厚度与功能评分同样不具有相关性。晚期膝OA滑膜炎的MRI厚度分级与膝关节功能及疼痛评分无相关性(rs＝0.17，P >0.05；rs＝0.32，P>0.05)。

结论

晚期膝OA滑膜炎的严重程度与主观评分无相关性，滑膜MRI厚度分级不能作为关节置换手术指征的判断标准，不能用滑膜炎严重程度决定是否需要行膝关节置换手术，也不能用主观评分来评估OA的病情发展、评价治疗。

关键词: 骨关节炎, 磁共振, 滑膜, 视觉模拟评分
Objective

To investigate if MRI findings of the thickness of synovitis could be used as criteria for the indications of knee replacement.

Methods

Thirty-one patients with end-stage knee osteoarthritis (OA) 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 zero to three on the basis of the thickness); (2) determination of knee-joint pain scores (visual analogue scale, VAS score) and functional scores Western Ontario and McMaster Univerisities Osteoarthrifis index, WOMAC) before total knee arthroplasty (TKA). Pearson’s linear test or Spearman rank test was used to analyze the correlation between synovial thickness and WOMAC OA index, and VAS score.

Results

Statistical analysis revealed no significant differences in MRI synovial thickening grade across the different regions of the knee.No correlation existed between the grades of MRI-determined thickness for synovitis and knee joint function scores with pain score (rs=0.17, P>0.05; rs=0.32, P >0.05), as well as no correlation existed between the different regions of the knee and the above factors respectively.

Conclusion

The grade of MRI-determined thickness of synovitis shows no correlation with the subjective scores in the patients with end-stage knee OA, thus the grades of MRI-determined thickness cannot be used as criteria for knee joint replacement indications, and further study on the relation among MRI, VAS and WOMAC scores is still warranted.

Key words: Osteoarthritis, Magnetic resonance imaging, Synovial membrane, Visual analog scale
图1 膝关节滑膜厚度测量示意图。左图为膝关节三维成像定位图，上方黄箭头示髌上囊水平面，下方黄箭头示内外侧间沟水平面；右上图为膝关节MRI轴位像，白色箭头示测量膝关节外侧、内侧髌上囊滑膜厚度；右下图为膝关节MRI轴位像，白色箭头示测量膝关节外侧和内侧间沟滑膜厚度
图2 膝关节MRI轴位像上Ostergaard滑膜厚度评级
图3 滑膜厚度与WOMAC(西安大略和麦克马斯特大学骨关节炎指数)功能评分相关性散点图
图4 滑膜厚度与VAS(疼痛视觉模拟评分)相关性散点图
表1 不同部位滑膜厚度与疼痛评分和功能评分的相关性
? 滑膜厚度与VAS疼痛评分 滑膜厚度与WOMAC功能评分
R值 P值 R值 P值
外侧间沟 0.306 0.094 0.354 0.051
外侧髌上囊 0.040 0.830 0.063 0.737
内侧间沟 0.054 0.775 －0.157 0.399
内侧髌上囊 0.436 0.014 －0.378 0.036
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