膝骨关节炎周围血供变化的影像学观察

Radiologic observation of the blood supply changes around the knee with osteoarthritis

目的:对比观察膝骨关节炎患者和正常人群膝关节周围血供变化。方法:2014年6月至2015年6月,纳入诊治的膝骨关节炎患者30例,健康成年人30例。膝骨关节炎组男9例,女21例,年龄53~82岁,平均(65.967±7.132)岁,平均动脉压(93.462±7.633)mm Hg;对照组男9例,女21例,年龄50~75岁,平均(62.867±6.356)岁,平均动脉压(92.122±9.675)mm Hg。检查方法包括彩超和下肢CTA;观察指标包括侧支循环,动脉迂曲,动脉畸形,管腔狭窄和动脉壁斑块形成情况。根据动脉的狭窄程度不同分为5级:1级为无狭窄,2级为轻度狭窄(1%~49%),3级为中度狭窄(50%~70%),4级为重度狭窄(70%~99%),5级为完全闭塞。测量两组的腘动脉、胫前动脉、胫后动脉内径的大小以及血流动力情况,并将膝骨关节炎组与对照组进行比较。结果:无剔除或脱落病例。膝骨关节炎组3例形成侧支循环,对照组4例;膝骨关节炎组0例动脉迂曲,对照组2例;两组均无动脉畸形。膝骨关节炎组动脉无狭窄0例,轻度14例,中度7例,重度9例,闭塞0例;对照组动脉无狭窄9例,轻度10例,中度6例,重度4例,闭塞1例;两组比较差异有统计学意义,膝骨关节炎组动脉狭窄比对照组严重。膝骨关节炎组30例动脉形成斑块,对照组20例形成斑块,两组比较差异有统计学意义,膝骨关节炎组动脉斑块形成比例高于对照组。膝骨关节炎组斑块钙化率100%,对照组63%。胫前动脉直径差异有统计学意义,膝骨关节炎组胫前动脉直径较大。两组腘动脉流速差异有统计学意义,膝骨关节炎组流速更快。胫后动脉流速差异有统计学意义,膝骨关节炎组流速更快。动脉流量方面,3条动脉数据比较差异均无统计学意义。结论:膝骨关节炎局部血管主要病理改变为狭窄和斑块形成,而局部动脉血流总量大致不变。临床治疗中改善局部血管病变的方法可能优于加速血流速度的方法,进一步针对局部血管异常改变的介入治疗也将为骨关节炎的临床治疗提供一个新的思路与方法。

Objective：To compare blood supply changes around the knee joint between normal and osteoarthritis knee.Methods：From June 2014 to June 2015,30 patients with knee osteoarthritis and 30 healthy adults were recruited. In osteoarthritis group,there were 9 males and 21 females,with a mean age of（65.967±7.132） years old（ranged,53 to 82 years old）,and the mean arterial pressure was（93.462±7.633） mm Hg. In control group,there were 9 males and 21 females,with a mean age of（62.867 ±6.356） years old（ranged,50 to 75 years old）,and the mean arterial pressure was（92.122 ±9.675）mm Hg. Inspection methods included color ultrasonic and computed tomography angiography of lower limbs. The patients were observed with：（1） collateral circulation;（2） artery circuity;（3） artery malformation;（4） artery stenosis;（5） arterial wall plaque formation. Stenosis was divided into 5 levels ：level 1 as no narrow,level 2 as mild stenosis（1% to 49%）,level 3 as moderate stenosis（50% to 70%）,level 4 as severe stenosis（70% to 99%）,level 5 as total obstruction. Diameter and blood flow dynamics of popliteal artery,pretibial artery,and posterior tibia artery in two groups were measured and compared. Results：The study was accomplished with complete data collection,none of the patients was eliminated,and there were no loss of follow up. There were 3 cases in OA group and 4 cases in control group with the formation of collateral circulation,and the difference had no statistically significance. There was none in OA group and 2 in control group with the formation of artery circuity,and the difference had no statistically significance. There were no cases in both groups with artery malformation. In OA group,there was mild in 14 cases,moderate in 7 cases,severe in 9 cases. In control group,there was no arterial stenosis in 9 cases,mild in 10 cases,moderate in 6 cases,severe in 4 cases,total obstruction in 1 case. The difference between two groups was statistically significant; artery stenosis in OA group was more severe than that of the control group. Artery plaque formed in 30 cases in OA group and in 20 cases in control group. The difference between two groups was statistically significant; the rate of artery plaque formation in OA group was obviously higher than that of control group. In OA group,plaque calcification rate was 100% while 63% in control group. Difference of pretibial artery diameter was statistically significant,pretibial artery diameter is larger in OA group. Difference of popliteal artery flow velocity was statistically significant;velocity was faster in OA group. Difference of the posterior tibial artery flow velocity was statistically significant; velocity was faster in OA group. The differences of the three arteries had no statistical significances in related to arterial flow. Conclusion：Local artery system changes with the onset of knee joint osteoarthritis. Main pathological changesof local blood vessels were stenosis and plaque formation,but the amount of local artery blood flow was roughly the same as the control group. Possible mechanism is that the local artery stenosis speed up the artery blood flow velocity,resulting local perfusion. The local tissue ischemia and hypoxia caused a series of pathological changes. It is better to improve local vascular lesions than to accelerate the blood flow velocity in clinical treatment. Further more,interventional therapy for vascular pathology will be a new trend of osteoarthritis treatment.