膝关节退行性骨关节病影像学分型与钙化层组织病理改变的关系

Relationship between X-ray typing and histopathological change of calcified layer in patients with degenerative osteoarthropathy in the knee

目的探讨膝关节退行性骨关节病影像学分型与钙化层组织病理改变的关系。方法行膝关节置换术膝关节退行性骨关节病患者43例(45膝),于术前行MRI及X线检查,依据病变累及部位分为髌股关节型(Ⅰ型)9膝,胫股关节型(Ⅱ型)11膝,髁间型(Ⅲ型)7膝,混合型(Ⅳ型)18膝。术后对股骨髁负重区取材切片,观察钙化层病理学改变,分析影像学分型与组织病理改变的关系。结果组织病理显示43例钙化层均有形态学改变,Ⅰ型中A型3膝,B型2膝,C型3膝,D型1膝,Ⅱ型中A型4膝,B型5膝,C型1膝,D型1膝,Ⅲ型中A型2膝,B型1膝,C型3膝,D型1膝,Ⅳ型中A型6膝,B型4膝,C型5膝,D型3膝。结论膝关节骨性关节炎患者股骨髁负重区钙化层均有形态学改变,不同影像学分型患者钙化层改变存在一定差异。

Objective To study the relationship between X-ray typing and the histopathologic changes of calcified layer in patients with degenerative osteoarthropathy in the knee. Methods Forty-three patients （45 knees） receiving total knee arthroplasty （TKA） for degenerative osteoarthropathy underwent MRI and X-ray examination before operation, and were divided into patello-femoral type （type Ⅰ） in 9 knees, tibial-femoral type （type Ⅱ） in 11 knees, intercondylar type （type Ⅲ ） in 7 knees and mixed type （type Ⅲ） in 18 knees according to the lesion locations. The paraffin sections were prepared after fixation and decalcification to observe the pathological changes in calcified layer. The correlation between the imaging and pathological change was analyzed. Results The histopathology results demonstrated 43 cases had morphological changes in calcified layer, including type ⅠAin 3 knees, type Ⅰ B in 2, type Ⅰ C in 3, type I D in 1; type ⅡA in 4, type ⅡBinS, type ⅡCinl, type ⅡDin1, type ⅢAin2, type ⅢBin 1, type ⅢCin3, type ⅢDin 1; type ⅣAin6, type ⅣB in 4, type ⅣC in 5, and type IV D in 3. Conclusion There are morphological changes in calcified layer in the weight-bearing area of the patients with degenerative osteoarthropathy. The patients with different imaging typing have differences in calcified layer.