晚期膝骨关节炎滑膜MRI厚度与疼痛及功能评分相关性

Correlation between grading of MRI-determined thickness of knee synovitis and knee joint function and pain scores in end-stage osteoarthritis

目的探讨晚期膝骨关节炎(OA)患者中滑膜厚度分级与膝关节疼痛及功能评分间的关系,从而明确滑膜炎的MRI厚度分级是否可用于作为膝关节置换的适应证标准。方法选择晚期膝OA患者31例,接受:①MRI对膝内、外侧间沟和内、外侧髌上囊4个观察部位滑膜的厚度进行分级测定,根据厚度可将滑膜炎程度分为0~3级;②全膝关节置换(TKA)术前的膝关节疼痛评分(VAS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)。采用Pearson线性相关或Spearman秩相关分析滑膜厚度分级与WOMAC以及VAS之间的相关性。结果晚期膝OA 4个观察部位滑膜的MRI厚度分级无显著性差异,不同部位滑膜厚度与疼痛评分不具有相关性,不同部位滑膜厚度与功能评分同样不具有相关性。晚期膝OA滑膜炎的MRI厚度分级与膝关节功能及疼痛评分无相关性(rs=0.17,P >0.05;rs=0.32,P>0.05)。结论晚期膝OA滑膜炎的严重程度与主观评分无相关性,滑膜MRI厚度分级不能作为关节置换手术指征的判断标准,不能用滑膜炎严重程度决定是否需要行膝关节置换手术,也不能用主观评分来评估OA的病情发展、评价治疗。

Objective To investigate if MRI findings of the thickness of synovitis could be used as criteria for the indications of knee replacement. Methods Thirty-one patients with end-stage knee osteoarthritis (OA) were selected and received the following examinations:(1) noninvasive MRI evaluation for grading the synovial thickness of the investigated sites (i.e., medial and lateral parapatellar recesses, and medial and lateral suprapatellar pouches;synovitis was categorized into grade zero to three on the basis of the thickness);(2) determination of knee-joint pain scores (visual analogue scale, VAS score) and functional scores Western Ontario and McMaster Univerisities Osteoarthrifis index, WOMAC) before total knee arthroplasty (TKA). Pearson’s linear test or Spearman rank test was used to analyze the correlation between synovial thickness and WOMAC OA index, and VAS score. Results Statistical analysis revealed no significant differences in MRI synovial thickening grade across the different regions of the knee.No correlation existed between the grades of MRI-determined thickness for synovitis and knee joint function scores with pain score (rs=0.17, P>0.05;rs=0.32, P >0.05), as well as no correlation existed between the different regions of the knee and the above factors respectively. Conclusion The grade of MRI-determined thickness of synovitis shows no correlation with the subjective scores in the patients with end-stage knee OA, thus the grades of MRI-determined thickness cannot be used as criteria for knee joint replacement indications, and further study on the relation among MRI, VAS and WOMAC scores is still warranted.