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中华关节外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (03) : 307 -313. doi: 10.3877/cma.j.issn.1674-134X.2026.03.007

临床论著

膝骨关节炎常用评分与影像学指标的相关性研究
黄颖琳1, 潘婉诗1, 彭琪琪2, 林皓健3, 刘昌盛1, 李桂元1, 何颖1, 邓宇2, 陆丽明4, 童娟1,()   
  1. 1 510120 广州医科大学附属第一医院中医科
    2 510120 广州医科大学附属第一医院放射科
    3 518055 深圳,南方科技大学
    4 510006 广州中医药大学华南针灸研究中心临床研究与大数据实验室
  • 收稿日期:2025-11-02 出版日期:2026-06-01
  • 通信作者: 童娟
  • 基金资助:
    广州市中医药特色诊疗技术项目(穗卫函[2022]2249号); 广州医科大学2024年科研能力提升计划重大临床研究项目(GMUCR2024-02016)

Correlation between common clinical scores and imaging indicators in knee osteoarthritis

Yinglin Huang1, Wanshi Pan1, Qiqi Peng2, Haojian Lin3, Changsheng Liu1, Guiyuan Li1, Ying He1, Yu Deng2, Liming Lu4, Juan Tong1,()   

  1. 1 Chinese Medicine Department of The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
    2 Radiology Department of The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
    3 Southern University of Science and Technology, Shenzhen 518055, China
    4 Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
  • Received:2025-11-02 Published:2026-06-01
  • Corresponding author: Juan Tong
引用本文:

黄颖琳, 潘婉诗, 彭琪琪, 林皓健, 刘昌盛, 李桂元, 何颖, 邓宇, 陆丽明, 童娟. 膝骨关节炎常用评分与影像学指标的相关性研究[J/OL]. 中华关节外科杂志(电子版), 2026, 20(03): 307-313.

Yinglin Huang, Wanshi Pan, Qiqi Peng, Haojian Lin, Changsheng Liu, Guiyuan Li, Ying He, Yu Deng, Liming Lu, Juan Tong. Correlation between common clinical scores and imaging indicators in knee osteoarthritis[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(03): 307-313.

目的

探讨膝骨关节炎不同疼痛积分患者的CT、MRI影像学指标差异。

方法

选取2024年4月至2025年9月在广州医科大学附属第一医院诊断为膝骨关节炎(KOA)且有膝关节疼痛40~80岁的46例患者为研究对象,排除有膝关节感染、合并重要器官严重疾病、出血倾向等患者。根据视觉模拟量表(VAS)评分≥3分为高积分组23例,评分<3分为低积分组23例。采用独立样本t检验或Mann-Whitney U检验比较两组患者的西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分及CT、MRI影像学指标的差异。

结果

在疼痛评分、僵硬评分、功能活动评分及WOMAC总分方面,高积分组均明显高于低积分组(Z=-6.213、-4.550、-6.067、-6.066,均为P<0.01)。CT影像学方面:在膝关节屈曲50度时,高积分组的髌骨倾斜角(PTA)与低积分组有明显差异(Z=-2.169,P<0.05)。MRI影像学方面:在任意软骨缺损占相应区域的百分比、全层软骨缺损占相应区域的百分比、骨赘、半月板信号异常、关节周围软组织征象方面,高积分组的评分均高于低积分组(Z=-2.256、-2.070、-1.975、-3.238、-2.220,均为P<0.05)。

结论

疼痛高积分患者的膝关节功能障碍明显高于低积分患者;同时,影像学提示疼痛积分水平与关节屈曲50°时PTA角度变窄及关节软骨损伤程度、骨赘、半月板变性、关节周围软组织的严重程度相关。

Objective

To investigate the differences in CT and MRI indicators between patients with knee osteoarthritis (KOA).

Methods

From April 2024 to September 2025, a total of 46 patients diagnosed with KOA and history of knee pain, aged from 40 to 80 years at the First Affiliated Hospital of Guangzhou Medical University were enrolled as the research subjects.The patients with knee infection, severe vital organs diseases, hemoragic tendency, etc. were excluded. According to the visual analogue scale (VAS) score, the patients were divided into two groups: the high-score group (VAS scoreequal or over three, n=23) and the low-score group (VAS scoreless than three, n=23). The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores, as well as CT and MRI imaging indicators, were compared between the two groups using independent samples t test or Mann-Whitney U test, as appropriate.

Results

The high-score group showed significantly higher scores in pain, stiffness, functional activity, and total WOMAC score than the low-score group (Z=-6.213, -4.550, -6.067, -6.066, all P<0.01). CT image findings: when the knee joint was flexed at 50 degrees, there was a significant difference in the patellar tilt angle (PTA) between the high-score group and the low-score group (Z=-2.169, P<0.05). MRI findings: the high-score group had higher scores than the low-score group in the following aspects: the percentage of cartilage defects in the corresponding area, the percentage of full-thickness cartilage defects in the corresponding area, osteophytes, meniscal signal abnormalities, and periarticular soft tissue signs (Z=-2.256, -2.070, -1.975, -3.238, -2.220, all P<0.05).

Conclusions

Patients in the high pain score group have significantly more severe knee joint dysfunction than those in the low pain score group. Meanwhile, imaging findings indicate that the level of pain score is associated with the narrowing of PTA when the knee joint is flexed at 50 degrees, as well as the severity of articular cartilage damage, osteophytes, meniscal degeneration, and periarticular soft tissue lesions.

图1 CT拍摄的角度垫枕。图A为屈膝15°;图B为屈膝50°
Figure 1 The angle pillow used for CT scanning. A shows knee flexion at 15°; B shows knee flexion at 50°
图2 膝关节CT影像学测量指标。图A为FTA(股骨滑车沟角);图B为CA(适合角);图C为PTA(髌骨倾斜角);图D为LPTA(外侧髌骨角);图E为PFI(髌股指数);图F为TT-TG(胫骨结节-滑车沟距离)
Figure 2 CT image measurements of the knee joint. A is FTA (femoral trochlear angle); B is CA (congruence angle); C is PTA (patellar tilt angle); D is LPTA (lateral patellar tilt angle); E is PFI (patellofemoral index); F is TT-TG (tibial tubercle-trochlear groove distance)
图3 MOAKS(MRI膝骨关节炎评分)骨区划分。图A为T2WI横轴位图像划分髌骨内侧区(M)与外侧区(L),髌骨顶点属于内侧亚区域(箭头所示);图B为T2WI矢状位,股骨划分为滑车区(T)、中央区(C)和后部区(P),胫骨均分为前部、中央及后部3部分;图C为T2WI冠状位,胫骨分为内侧区(M)、棘下区(S)及外侧区(L),股骨则分为内侧股骨髁和外侧股骨髁,髁间切迹属于股骨内侧
Figure 3 Bone region division of MOAKS (MRI osteoarthritis knee score). A shows the division of the patella into the medial region (M) and the lateral region (L), the patellar apex belongs to the medial subregion (arrow); B shows the division of the femur into the trochlear region (T), central region (C) and posterior region (P), the tibia is divided into anterior, central and posterior; C shows the division of the tibia into the medial region (M), subspinous region (S), and lateral region (L), and the femur is divided into the medial femoral condyle and the lateral femoral condyle, while the intercondylar notch belongs to the medial femur
表1 两组患者的一般资料比较
Table 1 Comparison of general data between the two groups
表2 两组患者WOMAC评分比较[MP25P75)]
Table 2 Comparison of WOMAC scores between the two groups
表3 膝关节屈曲15°时两组CT影像学指标比较
Table 3 Comparison of CT image findings between the two groups at knee flexion 15°
表4 膝关节屈曲50°时两组CT影像学指标比较
Table 4 Comparison of CT image findings between the two groups at knee flexion 50°
表5 两组患者的MRI影像学指标比较[MP25P75)]
Table 5 Comparison of MRI findings between the two groups
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