膝骨性关节炎患者膝关节局部骨密度的差异性研究

The difference in local bone mineral density at knee joint in patients with knee osteoarthritis

目的探讨膝骨关节炎患者膝关节不同分区骨密度差异性及其与骨质疏松情况的相关性。方法选取2016年3月至7月广东省中医院原发性膝骨性关节炎患者44例,共44膝(左膝22例,右膝22例);全部为绝经女性患者;年龄54~88岁,平均68.6±7.50岁。将膝关节感兴趣区(ROI)分别在正侧位上划分,正位分为6个感兴趣区,分别记为ROI 1-6区;侧位分为7个感兴趣,分别记为ROI 1-7区。利用双能X射线骨密度仪分别测量各个感兴趣区的骨密度,同时测量腰椎及股骨颈骨密度情况。根据测量结果,将不同分区BMD测量值分别进行两两间比较,采用SPSS 16.0的统计软件进行数据处理与分析。结果共纳入原发性膝骨性关节炎患者44例,腰椎BMD为0.859±0.156 g/cm2(0.592~1.168 g/cm2);股骨颈BMD为0.660±0.112 g/cm2(0.436~0.087 g/cm2)。其中骨质疏松(T值<-2.5)15例,占34.1%;低骨量(-1.0<T值<2.5)23例,占52.3%;正常(T值>-1.0)6例,占13.6%。膝关节正位感兴趣区ROI 1-6区BMD分别为:0.764±0.176、0.649±0.177、0.871±0.253、0.984±0.297、0.696±0.143、0.949±0.210。膝关节侧位感兴趣区ROI 1-7区BMD分别为:0.801±0.226、0.995±0.272、0.964±0.298、0.942±0.198、0.796±0.157、0.870±0.223、0.752±0.206。膝关节正位感兴趣区骨密度情况对比发现,ROI 1、ROI 2、ROI 3、ROI 4,四个分区相互间BMD测量值比较有统计学差异(P<0.05);其中BMD测量值ROI 4>ROI 3>ROI 1>ROI 2。膝关节侧位感兴趣区骨密度情况对比发现,ROI 1与ROI 2、ROI 3、ROI 4的BMD测量值比较有统计学差异(P<0.05);ROI 1 BMD测量值最小。ROI 4、ROI 6分别与ROI 5、ROI 7的BMD测量值比较有统计学差异(P<0.05);ROI 4、ROI 6的BMD测量值大于ROI 5、ROI 7的BMD测量值。结论膝骨关节炎患者大部分合并骨质疏松,膝骨关节炎与骨质疏松,相互影响,相互联系,导致疾病的不断发展。膝关节不同分区骨质量退变情况不同,胫骨平台内侧BMD测量值比胫骨平台外侧高,股骨外侧髁BMD测量值比股骨内侧髁;同时股骨髁、股骨干较胫骨平台、胫骨干、髌骨BMD测量值高。

Objective To investigate the difference in local bone mineral density at knee joint in patients with knee osteoarthritis.Methods The study participants were 44 patients with primary knee osteoarthritis who attended Guangdong Province Traditional Chinese Medical Hospital from March to July 2016,in total 44 knees were studied（22 cases of right knee,22 cases of left knee）.All participants were females,with an age range of 54 to 88 years old（average 68. 6 ± 7. 50 years）. The regions of interest（ROIs）were divided into coronal position and sagittal position. Coronal position was divided into 6 regions of interest,which were recorded as ROI 1-6; Sagittal position was divided into 7 ROIs,which were recorded as ROI 1-7. Bone mineral density（BMD） of each region of interest was measured by dual-energy X-ray bone densitometer. At the same time,BMD of lumbar spine and femoral neck were measured. Results In the 44 cases of primary knee osteoarthritis patients,lumbar BMD was 0. 859 ± 0. 156 g/cm2（0. 592 ~1. 168 g/cm2）,and femoral neck BMD was 0. 660 ± 0. 112 g/cm2（0. 436 ~ 0. 087 g/cm2）. Among them,15 cases（34. 1%） had osteoporosis（T-score -2. 5）; 23 cases（52. 3%） had low bone mass（-1. 0 T-score 2. 5）,and 6 cases（13. 6%） had normal BMD（T -1. 0）. The BMD of ROI 1-6 on the coronal position of the knee joint was： 0. 764 ± 0. 176,0. 649 ± 0. 177,0. 871 ± 0. 253,0. 984 ± 0. 297,0. 696 ± 0. 143 and 0. 949 ± 0. 210 g/cm2,respectively. The BMD of ROI 1-7 on the sagittalposition of the knee joint was： 0. 801 ± 0. 226,0. 995 ± 0. 272,0. 964 ± 0. 298,0. 942 ± 0. 198,0. 796 ± 0. 157,0. 870 ± 0. 223 and0. 752 ± 0. 206,respectively. Comparison of BMD in the coronal position area of the knee joint found that the BMD of ROI 1,ROI2,ROI 3 and ROI 4 were statistically different（P〈0. 05,ROI 4 ROI 3 ROI 1 ROI 2）. Comparison of BMD in the sagittal position area of the knee joint found that the BMD of ROI 1,ROI 2,ROI 3 and ROI 4 were statistically different（P〈0. 05）.Conclusion Most patients with knee osteoarthritis had osteoporosis. The BMD value of the medial tibial plateau was higher than that of the lateral tibial plateau,the BMD value of the lateral femoral condyle was higher than that of the medial condyle of femur,and the BMD values of the femoral condyle and femoral shaft were higher than those of the tibial plateau,tibia and patella.