补肾活血方对绝经后膝骨关节炎磁共振成像半定量评分的研究

A study on the correlation between the Bushen Huoxue prescription and MRI semi-quantitative score of the patients with postmenopausal knee osteoarthritis

目的:探讨补肾活血方对绝经后膝骨关节炎患者磁共振成像(Magnetic Resonance Imaging,MRI)影像学特征的影响。方法:选取绝经后膝骨关节炎患者70例,采用随机数字表法分为治疗组和对照组。最终纳入67例完成研究,其中治疗组33例给予补肾活血方,对照组34例给予塞来昔布胶囊。分别通过全器官磁共振成像评分系统(Whole-Organ Magnetic-ResonanceImaging Score,WORMS)评价治疗前后膝关节MRI中关节软骨、软骨下骨髓水肿、关节面下囊肿、半月板及关节腔积液的影像学变化。结果:补肾活血方可降低软骨下骨髓水肿和关节腔积液半定量评分(P <0.01);而对关节软骨损伤、关节面下囊肿、半月板变性损伤评分几乎无影响(P> 0.05)。同时软骨损伤评分与K-L分级、半月板变性损伤呈良好的正相关关系(r=0.589,P <0.01;r=0.582,P <0.01),与软骨下骨髓水肿呈弱正相关(r=0.317,P <0.01)。结论:早、中期绝经后膝骨关节炎MRI影像以髌股关节和内侧胫股关节损伤最为常见,补肾活血方可改善软骨下骨髓水肿和关节腔积液。研究显示对于绝经后膝骨关节炎应早发现、早干预、早治疗,以减少不可逆的病理变化对骨关节各组成结构和功能的影响。

Objective:To investigate the effect of the Bushen Huoxue prescription(补肾活血方)on MRI imaging characteristics of postmenopausal knee osteoarthritis patients.Methods:Seventy postmenopausal patients with knee osteoarthritis were selected and divided into the treatment group and the control group by random number table method.Finally,sixty-seven cases were included to complete the study,among which 33 cases in the treatment group were given the Bushen Huoxue prescription,and 34 cases in the control group were given celecoxib capsules.The WORMS score system was used to evaluate the imaging changes of articular cartilage,subchondral bone marrow edema,subarticular cyst,meniscus and articular cavity effusion in MRI of knee joint before and after treatment.Results:The Bushen Huoxue prescription decreased the subchondral bone marrow edema and the semi-quantitative score of articular cavity effusion(P<0.01),but had no effect on the scores of articular cartilage injury,subarticular cyst and meniscus degeneration injury(P>0.05).Meanwhile,the cartilage injury score was positively correlated with K-L grading and meniscus degeneration injury(r=0.589,P<0.01;r=0.582,P<0.01),was weakly positively correlated with subchondral bone marrow edema(r=0.317,P<0.01).Conclusion:Early postmenopausal knee osteoarthritis patients’MRI image injury of patellofemoral joint and the medial tibial joint is the most common,and the Bushen Huoxue prescription can ameliorate subchondral bone marrow edema and joint cavity effusion.Knee osteoarthritis after menopause should be detected,interfered with and treated as early as possible,in order to reduce the impact of the irreversible pathological changes on the joint of the structure and function.