膝骨性关节炎患者胫骨软骨下骨超微结构改变的CT评价

Ultrastructural changes of tibial subchondral bone in patients with knee osteoarthritis: CT evaluation

背景:软骨下骨的改变在膝骨性关节炎的作用得到了越来越多的重视,但是既往研究主要以动物为观察对象,由于动物与人存在差异,因而直接在人体关节内获得相关数据是非常必要的。目的:通过CT技术评价非膝骨性关节炎患者与膝骨性关节炎患者软骨下骨板及软骨下骨超微结构的区别,来探讨软骨下骨在膝骨性关节炎疾病的发生和发展中的作用。方法:于2016年7月至2018年7月在郑州市骨科医院影像科就诊患者中,收集30例膝骨性关节炎患者(膝骨性关节炎组)及30例非膝骨性关节炎患者(非膝骨性关节炎组)的CT扫描数据,使用MIMICS软件比较2组胫骨平台内外侧软骨下骨板以及软骨下骨小梁超微结构。试验于2016-06-10经郑州市骨科医院伦理委员会审批通过,审批号为2016医院伦审第004号。结果与结论:①与非膝骨性关节炎组相比,膝骨性关节炎组软骨下骨板在外侧部位和内侧部位骨密度都明显增加,孔隙率则出现显著的下降,而软骨下骨板厚度内侧部分较非膝骨性关节炎组显著增厚;②膝骨性关节炎软骨下骨小梁同样存在明显变化,表现为膝骨性关节炎组内外侧软骨下骨骨小梁厚度较非膝骨性关节炎组均明显增加,同时内侧松质骨分离度也较非膝骨性关节炎组低;膝骨性关节炎组结构模型指数和连接密度值低于非膝骨性关节炎组;③结果表明,膝骨性关节炎患者胫骨软骨下骨板及软骨下骨松质骨的改变主要在于超微结构稳态的破坏,这一改变可能是膝骨性关节炎发病原因之一。

BACKGROUND:More and more attention has been paid to the role of subchondral bone changes in knee osteoarthritis.However,previous studies mainly focused on animal experiments.Animals and humans have certain differences,so it is very necessary to obtain relevant data directly in human joints.OBJECTIVE:To evaluate the difference of subchondral plate and subchondral bone ultrastructure between normal patients and patients with knee osteoarthritis by CT technique,so as to explore the role of subchondral bone in the occurrence and development of knee osteoarthritis.METHODS:CT scan data of 30 patients with knee osteoarthritis(knee osteoarthritis group)and 30 patients without knee osteoarthritis(non-knee osteoarthritis group)were collected from the Department of Imaging of Zhengzhou Orthopedic Hospital from July 2016 to July 2018.Subchondral plate and subchondral bone ultrastructure of medial and lateral tibial plateau was compared between the two groups using MIMICS software.This study was approved by the Ethics Committee of Zhengzhou Orthopedic Hospital on June 10,2016(approval No.2016004).RESULTS AND CONCLUSION:(1)Compared with the non-knee osteoarthritis group,bone density was significantly increased and porosity was significantly decreased in the subchondral bone plate in the knee osteoarthritis group in both the lateral and medial parts,while the medial part of subchondral bone plate thickness was significantly thicker than that in the non-knee osteoarthritis group.(2)There were also significant changes in subchondral trabeculae in the knee osteoarthritis group,which showed that the thickness of subchondral trabeculae in the lateral part and the medial part of the subchondral bone in the knee osteoarthritis group was significantly increased compared with the non-knee osteoarthritis group.Meanwhile,in the medial part,the degree of cancellous bone separation in the knee osteoarthritis group was significantly lower than that in the non-knee osteoarthritis group.Structure model index and connectivity density in the knee osteoarthritis group were significantly lower than those of the non-knee osteoarthritis group.(3)Results show that the change of tibial subchondral bone plate and subchondral cancellous bone in knee osteoarthritis patients mainly lies in the destruction of ultrastructure homeostasis.This change may be one of the causes of knee osteoarthritis.