类风湿关节炎膝关节骨髓水肿病变的影像学研究

Bone marrow edema in rheumatoid arthritis knee: a study based on MRI

[目的]调查和评估类风湿关节炎(RA)人群中骨髓水肿(BME)的分布状况,分析相关因素,为进一步的研究提供临床依据。[方法] 2015年1月～2018年5月,共有64例64膝纳入本研究,右侧42例,左侧22例,男性8例,女性56例,平均年龄(61.69±10.89)岁。对拟行人工关节置换术的膝关节行MRI平扫,参照全关节磁共振评分系统(WORMS评分)的方法,对BME进行评估、分级,记录性别、年龄、身体质量指数(BMI)、膝疼痛评分(VAS评分)、特种外科医院膝功能评分(HSS评分)、红细胞沉降率(ESR)、C反应蛋白(CRP)、膝平片Lar?son评级等资料,将BME程度与上述资料进行等级相关分析。[结果] 64患者中, 48例存在BME(75%),16例BME分布于关节一侧,32例两侧均有分布。BME分级以2级和3级较多,分别达到了16例和20例,占总数的56.25%。Spearman相关分析显示BME程度与HSS评分呈负相关(r=-0.585,P<0.01),与VAS评分呈正相关(r=0.691,P<0.01),与CRP呈正相关(r=0.368,P<0.05)。[结论] BME在膝关节中晚期病变中广泛存在且多较为严重,BME严重者疼痛更剧烈,关节功能减退也更为显著。

[Objective] To investigate occurrence of bone marrow edema(BME) in knee rheumatoid arthritis(RA), and the correlation among BME and the other clinical parameters to lay a foundation for further clinical studies. [Method] From January2015 to May 2018, a total of 64 patients(64 knees) who were candidates of total knee arthroplasty for RA were enrolled into this study, including 8 males and 56 females aged for an average of(61.69±10.89) years, involving 42 right knees and 22 left knees.Based on the knee MRI taken, the extent of BME was graded by using the method described in whole-organ magnetic resonance score(WORMS). In addition, clinical data were recorded, such as age, body mass index(BMI), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), knee function evaluated by Hospital for Special Surgery(HSS) score, and joint destruction graded with Larson scale on radiograph. The relationships between BME and other parameters were analyzed with Spearman rank correlation. [Results] Of the 64 patients, 48 cases were proved of BME accounted for 75%, involving unilateral knee in 16 cases and bilateral knees in 32 patients. Most of BME were marked as Grade II and III, the former was found in 16 cases and thelatter in 20 cases respectively, accounted for 56%. Spearman rank correlation analysis revealed that the BME extent was negatively related to HSS score(r=-0.585, P<0.01), while positively related to the VAS(r=0.691, P<0.01) and CRP(r=0.368, P<0.05). [Conclusion] BME is a common presenta-tion in advanced knee rheumatoid arthritis. With the progress of BME, knee pain increase, whereas knee function decrease.