核磁共振成像在杜式手法治疗膝关节骨性关节炎中的应用与评价

Application of magnetic resonance imaging in evaluating the effects of manipulation on knee osteoarthritis

目的:采用核磁共振成像(magnetic resonance imaging,MRI)技术和T2-mapping成像技术对中医手法治疗膝关节骨性关节炎的疗效进行观察和评价。方法:2005年10月～2008年1月就诊于上海瑞金医院伤骨科的膝关节骨性关节炎患者45例,男9例,女36例;年龄34～85岁,平均年龄(57.4±6.1)岁。所有患者行杜式手法治疗,每周治疗1～2次,共治疗12个月。所有患者在治疗前和各疗程间均进行患侧膝关节磁共振成像,各患者行磁共振后随访3～6次不等。分别获得各区域软骨厚度、软骨缺损的MRI分级、软骨信号容积、髌软骨和股骨髁软骨T2-mapping值及伪彩图和软骨下骨髓水肿的面积。结果:治疗6个月后,髌软骨和股骨髁软骨厚度均显著增加(t髌骨=9.57,P>0.05;t股骨髁=11.59,P>0.05),治疗12个月后,软骨容积亦显著增加(F=14.64,P<0.01)。治疗3个月后,Recht评分较治疗前显著改善(Z=17.96,P<0.05)。治疗9个月后,膝关节软骨T2-mapping示髌软骨T2值有降低表现(F=3.11,P<0.05)。治疗3个月后,股骨软骨下骨髓水肿的体积明显缩小(t=-4.53,P<0.01);治疗6个月后,髌骨软骨下骨髓水肿已经消除(t=-5.53,P<0.01)。结论:以MRI作为检测手段,初步证明膝关节骨性关节炎的手法治疗手段能促进软骨修复和软骨下骨髓水肿吸收。

Objective： To observe and evaluate the effects of manipulation on knee osteoarthritis （KOA） using T2- mapping and magnetic resonance imaging （MRI）-based volume measurements. Methods： Forty-five cases of KOA were involved retrospectively in the study, and the patients were composed of 9 males and 36 females with the mean age of （57.4±6.1） years. The cases were treated with manipulative therapy once or twice per week for 12 months. MRI of each knee was performed separately by using 1. 5-T MRI equipment before and during the treatment. Average cartilage depth, MRI grading of cartilage defects, cartilage volume, average T2 values in patella cartilage and femoral condyle, and bone marrow edema area were detected respectively. Results： The knee joint cartilage thickness from MRI began to increase after 6-month treatment （P〈0.05）. The cartilage volume increase was obviously observed after 12-month treatment, and there was a significant difference （F=14.64, P〈0.01）. MRI grading of cartilage defects decreased from Ⅲ A to Ⅱ B after 3-month treatment （Z=17. 96, P〈0. 05）. The average T2 value in patella cartilage decreased after 9-month treatment （F=3.11, P〈0.05）, but there were no differences in cartilage from tibial plateau and femoral condyle compartments after the treatment. The bone marrow edema area in femoral condyle began to diminish at 3-month treatment （t=-4.53, P〈0.01）, and the bone marrow edema area in cartilage patella was diminished after 6-month treatment （t=- 5.53, P〈0.01）. Conclusion： T2-mapping and cartilage volume measurement are suitable for evaluating the manipulative therapy on KOA. Traditional Chinese manipulation therapy is an effective method for KQA in the cartilage recovery.