重度膝骨关节炎患者骨髓水肿与骨质疏松的相关性研究

Study on correlation between bone marrow edema and osteoporosis in patients with severe knee osteoarthritis

目的:探讨重度膝骨关节炎患者骨髓水肿与骨质疏松的关系。方法:采用非匹配型病例对照研究,自2020年1月至2021年3月收治已行膝关节MRI及双能X线吸收测定法(dualenergy X-ray absorptiometry,DXA)骨密度(bone mineral density,BMD)检查的160例重度膝骨关节炎患者,其中合并骨髓水肿的患者80例为骨髓水肿组,不合并骨髓水肿的患者80例为无骨髓水肿组。骨髓水肿组男12例,女68例;年龄51~80(66.58±8.10)岁;病程5~40(15.61±9.25)个月;身体质量指数(body mass index,BMI)21.81~34.70(27.79±3.00)kg·m^(-2);Kellgren-Lawrence(K-L)分级,Ⅲ级25例,Ⅳ级55例。无骨髓水肿组男15例,女65例;年龄50~80(67.82±8.05)岁;病程6~37(15.75±8.18)个月;BMI 21.39~34.46(28.26±3.13)kg·m^(-2);K-LⅢ级38例,Ⅳ级42例。采用膝关节整体磁共振成像评分(whole oragan magnetic resonance imaging score,WORMS)评价骨髓水肿程度,以DXA检查T值诊断骨质疏松、评价骨密度。比较两组患者骨质疏松的患病率,采用Spearman相关性分析骨髓水肿组患者骨髓水肿WORMS评分与DXA骨密度T值的相关性。结果:两组患者均于初诊时获得完整病例资料,无脱落或剔除,两组性别、年龄、病程、BMI比较,差异无统计学意义(P>0.05)。骨髓水肿患者K-LⅣ级所占比例高于无骨髓水肿组患者(P<0.05);骨髓水肿组患者骨质疏松患病率均分别高于同K-L等级中无骨髓水肿组患者,差异有统计学意义(P<0.05);骨髓水肿组患者骨髓水肿WORMS评分与DXA骨密度T值为强负相关(r=-0.812,|r|=0.812>0.8,P<0.001)。结论:骨质疏松是重度膝骨关节炎骨髓水肿的危险因素之一,骨密度越低越易导致骨髓水肿。

Objective To explore relationship between bone marrow edema(BME)and osteoporosis in patients with severe knee osteoarthritis.Methods Unmatched case-control study was conducted.Totally 160 patients with severe knee osteoarthritis who had undergone knee magnetic resonance imaging(MRI)and bone mineral density examination(BMD)from January 2020 to March 2021 were included.Eighty patients complicated with BME were included in BME group,and 80 patients without BME were selected as NBME group.In BME group,there were 12 males and 68 females,aged from 51 to 80 years old with an average of(66.58±8.10)years old;the courses of disease ranged from 5 to 40 months with an average of(15.61±9.25)months;body mass index(BMI)ranged from 21.81 to 34.70 with an average of(27.79±3.00)kg·m^(-2);25 patients classified to gradeⅢand 55 patients gradeⅣaccording to Kellgren-Lawrence(K-L).In NBME group,there were 15 males and 65 females,aged from 50 to 80 years old with an average of(67.82±8.05)years old;the course of disease ranged from 6 to 37 months with an average of(15.75±8.18)months;BMI ranged from 21.39 to 34.46 with an average of(28.26±3.13)kg·m^(-2);25 patients were K-LⅢand 55 patients with K-LⅣ.The degree of bone marrow edema was evaluated by knee whole oragan magnetic resonance imaging score(WORMS).Osteoporosis was diagnosed and BMD was evaluated by DXA T value.To explore the relationship between bone marrow edema and osteoporosis by comparing prevalence rate of osteoporosis between two groups,and to further explore relationship between BME and BMD by Spearman correlation analysis of BME WORMS score and DXA T value in BME group.Results The complete case data were obtained on the first diagnosis,and there was no significant difference in sex,age,courses of disease and BMI between two groups(P>0.05).The proportion of K-LⅣin BME group was significantly higher than that in NBME(P<0.05).The prevalence rate of osteoporosis in BME group was significantly higher than in NBME group with the same K-L grade(P<0.001),and there was a strong negative correlation between BME WORMS score and DXA BMD T value(r=-0.812,|r|=0.812>0.8,P<0.001).Conclusion Osteoporosis is one of the risk factors of bone marrow edema in patients with severe knee osteoarthritis,and the lower the bone mineral density is,the easier it is to be complicated with bone marrow edema.