MRI对体外冲击波联合康复运动治疗膝关节骨性关节炎短期疗效的评估

Evaluation of Short-Term Rfficacy of Extracorporeal Shock Wave Combined with Rehabilitation Exercise for Knee Osteoarthritis by MRI

目的通过MRI评估体外冲击波(ESW)联合康复运动对膝关节骨性关节炎(KOA)的治疗效果,探讨和临床症状相关的MR表现。方法研究对象来自前瞻性研究“体外冲击波治疗膝关节骨性关节炎的临床疗效研究”的人群,共62例KOA患者的临床和影像学资料。治疗前和治疗后3个月行膝关节MR检查和临床评分。采用全膝关节磁共振成像评分(WORMS)评价患者的影像学特征,并测量髌上囊积液面积。采用疼痛视觉模拟量表(VSA)、西安大略大学和麦克马斯特大学骨性关节炎指数(WOMAC)评价治疗效果。比较治疗前和治疗后MR表现和临床评分,做MR表现和临床症状的回归分析。结果治疗前和治疗3个月后,患者的骨髓水肿评分、关节积液面积、VSA评分、WOMAC评分均有显著性差异(P<0.05),治疗后小于治疗前。WORMS评分中的软骨损伤评分对VAS的影响有显著性。结论MRI的骨髓水肿评分、关节积液面积可反映治疗效果。MRI的软骨损伤评分和疼痛相关。ESW联合康复运动对KOA有积极作用,可显著地缓解患者的关节积液、骨髓水肿和临床症状,改善关节功能。

Objective To evaluated the therapeutic effect of extracorporeal shock wave(ESW)combined with rehabilitation exercise on knee osteoarthritis(KOA)by MRI,and explored the correlation between MR findings and clinical symptoms.Methods The clinical and image data of 62 KOA patients were obtained from a prospective study of extracorporeal shock wave for knee osteoarthritis.MR examination and clinical scoring of knee were performed before treatment and after 3 months of treatment.The Whole-Organ Magnetic Resonance Imaging Score(WORMS)was used to evaluate the MR findings and the area of bursae suprapatellaris fluid was measured.Visual Analogue Scale(VSA)and the Western Ontario and MeMaster Universities Osteoarthritis Index(WOMAC)were used to evaluate the therapeutic effect.Pre-treatment and post-treatment MR findings and clinical scores were compared and the regression analysis of MR findings and clinical symptoms was analyzed.Results Bone marrow edema,area of joint effusion,VSA and WOMAC were significantly different in pre-treatment and post-treatment(P<0.05).The cartilage score and VAS were significantly correlated.Conclusion Bone marrow edema and joint effusion area of MRI can reflect the treatment effect.Cartilage scores in MRI correlate with pain.ESW therapy combined with rehabilitation exercise has a positive effect on knee osteoarthritis,which can significantly alleviate joint effusion,bone marrow edema and clinical symptoms in patients.