维吾尔医3种异常体液质类型膝骨关节炎患者的MRI特征研究

MRI characteristics of knee osteoarthritis in patients with three kinds of abnormal physical constitution(Uygur medicine) : a clinical study

目的:探讨维吾尔医3种异常体液质类型膝骨关节炎(knee osteoarthritis,KOA)患者的MRI特征。方法:2016年2月至2017年12月收治151例KOA患者,男42例、女109例。按照KOA维吾尔医体液质分型标准对患者进行辨证分型,同时对所有患者的膝关节进行MRI检查。比较3种异常体液质类型患者的MRI表现,探讨其特征。结果:石膏状黏液质型50例、涩味黏液质型51例、异常干寒体液质型50例。MRI显示141例存在不同程度的关节积液(石膏状黏液质型46例、涩味黏液质型45例、异常干寒体液质型50例)、129例存在骨质增生(石膏状黏液质型41例、涩味黏液质型44例、异常干寒体液质型44例)、100例存在半月板损伤(石膏状黏液质型31例、涩味黏液质型36例、异常干寒体液质型33例)、67例存在骨髓水肿(石膏状黏液质型19例、涩味黏液质型23例、异常干寒体液质型25例)、25例存在腘窝囊肿(石膏状黏液质型2例、涩味黏液质型4例、异常干寒体液质型19例)、22例存在关节游离体(石膏状黏液质型1例、涩味黏液质型1例、异常干寒体液质型20例)、9例存在软骨损伤(石膏状黏液质型7例、涩味黏液质型2例)、5例存在关节囊周围静脉曲张(涩味黏液质型2例、异常干寒体液质型3例)、5例存在韧带损伤(涩味黏液质型1例、异常干寒体液质型4例)、4例存在皮下软组织损伤(涩味黏液质型1例、异常干寒体液质型3例)、3例存在髌骨软骨软化(石膏状黏液质型1例、涩味黏液质型1例、异常干寒体液质型1例)。3种体液质类型患者骨质增生(χ~2=0.767,P=0.681)、半月板损伤(χ~2=0.834,P=0.659)、骨髓水肿(χ~2=0.560,P=0.756)、韧带损伤(χ~2=4.375,P=0.087)、关节囊周围静脉曲张(χ~2=2.865,P=0.288)、皮下软组织损伤(χ~2=2.973,P=0.224)、髌骨软骨软化(χ~2=0.432,P=1.000)的发生率比较,组间差异均无统计学意义。3种体液质类型患者关节积液的发生率总体比较,差异有统计学意义(χ~2=6.537,P=0.036);但两两比较,差异均无统计学意义。3种体液质类型患者腘窝囊肿的发生率比较,差异有统计学意义(χ~2=25.159,P=0.000);异常干寒体液质型腘窝囊肿的发生率高于石膏状黏液质型和涩味黏液质型(χ~2=17.420,P=0.000;χ~2=13.056,P=0.000);石膏状黏液质型和涩味黏液质型腘窝囊肿的发生率比较,差异无统计学意义(χ~2=0.157,P=0.692)。3种体液质类型患者关节游离体的发生率比较,差异有统计学意义(χ~2=38.840,P=0.000);异常干寒体液质型关节游离体的发生率高于石膏状黏液质型和涩味黏液质型(χ~2=27.760,P=0.000;χ~2=22.180,P=0.000);石膏状黏液质型和涩味黏液质型关节游离体的发生率比较,差异无统计学意义(χ~2=0.000,P=1.000)。3种体液质类型患者软骨损伤的发生率总体比较,差异有统计学意义(χ~2=8.430,P=0.008);但两两比较,差异均无统计学意义。结论:维吾尔医3种异常体液质类型KOA患者的MRI表现具有一定的特点,腘窝囊肿和关节游离体多见于异常干寒体液质型患者。

Objective：To explore the MRI characteristics of knee osteoarthritis（KOA） in patients with three kinds of abnormal physicalconstitution（Uygur medicine）. Methods：One hundred and fifty - one patients with KOA were recruited from February 2016 to December2017. The patients consisted of 42 males and 109 females. The patients were classified according to physical constitution（Uygur medicine）classification standards of KOA, and MRI examination were performed on knee joints of all patients. The MRI findings of the patients werecompared between the three kinds of abnormal physical eonstitution（Uygur medicine）and the MRI characteristics were explored. Results：The physical constitutions （Uygur medicine）of patients belonged to plaster phlegmatic type （50）, astringency phlegmatic type （51 ）and ab-normal dry - cold humor type（50） respectively. The results of MRI examination on knee joints showed hydrops articuli at different degrees in141 cases （ plaster phlegmatic type （46）, astringency phlegmatic type （45） and abnormal dry - cold humor type （50） ）, hyperosteogeny in 129cases（ plaster phlegmatic type （41）, astringency phlegmatic type（44）and abnormal dry cold humor type（44））, meniscus injury in 100cases（ plaster phlegmatic type（ 31 ）, astringency phlegmatic type（ 36 ） and abnormal dry cold humor type（ 33 ） ）, bone marrow edema in 67cases （ plaster phlegmatic type （ 19 ）, astringency phlegmatic type （ 23 ） and abnormal dry cold humor type （ 25 ） ）, popliteal cyst in 25 cases（ plaster phlegmatic type （ 2 ）, astringency phlegmatic type （4） and abnormal dry cold humor type （ 19 ） ）, articular loose body in 22 cases（plaster phlegmatic type （ 1 ）, astringency phlegmatic type （ 1 ）and abnormal dry cold humor type （20））, articular cartilage injury in 9 ca-ses （plaster phlegmatic type （7）and astringency phlegmatic type （2） ）, varicose veins around the joint capsule in 5 cases（ astringency phleg-marie type（2） and abnormal drycold humor type（ 3 ））, ligament injury in 5 cases （astringency phlegmatic type （1）and abnormal drycold humor type （4） ）, subcutaneous soft tissue injury in 4 cases （ astringency phlegmatic type （ 1 ） and abnormal dry cold humor type （ 3 ） ）and ehondromalaeia patellae in 3 cases（ plaster phlegmatic type （ 1 ）, astringency phlegmatic type （ 1 ） and abnormal dry - cold humor type（ 1 ） ）. There were no statistical difference in the incidences of hyperosteogeny（χ2 = 0. 767,P = 0. 681 ）, meniscus injury（χ2 = 0. 834, P =0. 659） ,bone marrow edema（χ2 = 0. 560, P = 0. 756 ）, ligament injury0（2 = 4. 375, P = 0. 087 ）, varicose veins around the joint capsule（χ2 = 2. 865, P = 0. 288 ）, subcutaneous soft tissue injury（χ2 = 2. 973, P = 0. 224） and chondromalacia patellae （χ2 =0. 432,P = 1. 000） be-tween the three kinds of humor types. There was statistical difference in the incidence of hydrops artieuli between the three kinds of humortypes in general（χ2 = 6. 537,P = 0.036）. Further pairwise comparison showed that there was no statistical difference in the incidence of bydrops artieuli between different humor types. There was statistical difference in the incidence of popliteal cyst between the three kinds of hu-mor types（χ2 = 25. 159, P = 0. 000）. The incidence of popliteal cyst was higher in abnormal dry cold humor type compared to plasterphlegmatic type and astringency phlegmatic type（χ2 = 17. 420 ,P =0. 000 ;X2 = 13. 056 ,P = 0. 000）, and there was no statistical differencein the incidence of popliteal cyst between plaster phlegmatic type and astringency phlegmatic type（χ2 = 0. 157,P = 0. 692）. There was sta-tistical difference in the incidence of articular loose body between the three kinds of humor types（χ2 = 38. 840,P =0.000）. The incidenceof articular loose body was higher in abnormal dry - cold humor type compared to plaster phlegmatic type and astringency phlegmatic type （χ = 27. 760,P = 0. 000;χ 2= 22. 180,P = 0. 000）, and there was no statistical difference in the incidence of articular loose body between plaster phlegmatic type and astringency phlegmatic type （χ2 = 0. 000, P = 1. 000）. There was statistical difference in the incidence of articu- lar cartilage injury between the three kinds of humor types in general（χ2 = 8. 430, P = 0. 008）. Further pairwise comparison showed that there was no statistical difference in the incidence of articular cartilage injury between different kinds of humor types. Conclusion ： MRI manifestations of KOA of patients with three kinds of abnormal physical constitution（ Uygur medicine）presents some characteristics. Popliteal cyst and articular loose body occur more frequently in patients with abnormal dry -cold humor type physical constitution（ Uygur medicine）.