膝骨性关节炎的超声表现特点及其相关性研究

Study on musculuskeletal ultrasound features and correlation of knee osteoarthritis

目的:通过比较膝骨性关节炎患者膝关节肌骨超声表现与膝关节功能障碍、X线表现的相关性,分析膝关节周围软组织炎症在膝骨性关节炎中的病理作用机制。方法:应用横断面研究方法(证据等级为Ⅲ级)。根据病例筛选标准收集整理2016年9月至2017年1月就诊于门诊的膝骨性关节炎患者,采集全部患者膝关节肌骨超声、X线图像,填写Lysholm膝关节功能评价量表。应用Pearson相关系数检验、t检验及秩和检验分析肌骨超声表现与Lysholm评分、X线表现的相关性。结果:共纳入123例膝骨性关节炎患者。膝关节周围软组织炎症在膝骨性关节炎患者中具有较高的发病率(髌下脂肪垫炎81%),并且滑膜厚度、积液深度、半月板膨出程度均超过了正常范围。相关性分析显示:Lysholm功能障碍评分方面,膝关节积液深度与"下蹲"评分呈负相关(r=-0.21,P=0.02),内侧半月板膨出程度与"支撑"评分呈明显负相关(r=-0.26,P<0.01),并与Lysholm总分呈负相关(r=-0.19,P=0.04),外侧半月板膨出程度则与"不稳定"评分呈负相关(r=-0.22,P=0.02)。X线表现方面,膝关节内侧间隙狭窄程度与关节积液深度(r=-0.27,P<0.001),滑膜增生厚度呈负相关(r=-0.17,P=0.007),与内侧半月板膨出程度呈正相关(r=0.18,P=0.04),与髌韧带止点炎症、髌下脂肪垫炎有相关性(P<0.05),外侧关节间隙狭窄程度则与"髌韧带止点炎症"有相关性(P=0.02)。结论:膝关节周围软组织炎症是KOA患者的主要病理表现,并与膝关节功能障碍、骨性结构病变具有显著相关性,通过影响膝关节功能、促进关节软骨破坏从而影响KOA的疾病进程。

Objective:To compare the correlation between musculoskeletal ultrasound features,dysfunction and X-ray findings in patients with knee osteoarthritis,and to analyze the pathological mechanism of soft tissue inflammation in knee osteoarthritis. Methods:Cross-sectional method was performed in this research(Evidence level:Ⅲ). The patients with knee osteoarthritis were collected according to the screening criteria from September 2016 to January 2017 in Orthopedic clinic in our hospital. Musculoskeletal ultrasound and X ray images were obtained and measured,knee function was measured by Lysholm scale. Pearson coefficient,t test and Wilcoxon were applied to analyze the correlation between soft tissue inflammation,knee dysfunction and X-ray features. Results:Total 123 patients with knee osteoarthritis were recruited in this research. Soft tissue inflammation around knee had a high incidence in patients with knee osteoarthritis(infrapatellar fat pad inflammation 81%),and the synovial membrane thickness,joint effusion depth and meniscus bulging were beyond the normal range. Correlation analysis showed that the about Lysholm score and joint effusion depth had negative correlations with "Squat" score(r=-0.21,P=0.02). and Medial meniscus bulging had negative correlations with "Sustain" score(r=-0.26,P<0.01) and Lysholm total score(r=-0.19,P=0.04). Lateral meniscus bulging had a negative correlation with "Unstable" score(r=-0.22,P=0.02). The X-ray features,and medial joint space narrow had negative correlations with joint effusion depth(r=-0.27,P<0.01) and synovial membrane thickness(r=-0.17,P=0.007),and had a positive correlation with medial meniscus bulging. Medial joint space narrow was significantly correlated with patellar ligament inflammation and fat pad inflammation(P<0.05). Lateral joint space narrow was significantly correlated with patellar ligament inflammation(P=0.02). Conclusion:Soft tissue inflammation around the knee-a major pathological manifestation of knee osteoarthritis,has significant correlations with knee dysfunction and bony structure lesions,and affects the progression of knee osteoarthritis by damaging knee joint function and promoting the destruction of articular cartilage.