摘要
目的探讨MRI显示的软骨下骨髓水肿程度与膝骨关节炎疼痛程度的相关性。方法膝骨关节炎患者共264例,按疼痛程度分为三组:无疼痛组47例,轻度疼痛组184例,中重度疼痛组33例;根据X线检查Kellgren-Lawrence(K-L)分级标准将膝骨关节炎分为三度:轻度(K-L分级Ⅱ级)52例,中度(K-L分级Ⅲ级)142例,重度(K-L分级Ⅳ级)70例;将MRI诊断的骨髓水肿分为三级:0级(无骨髓水肿)69例,1级(轻度骨髓水肿)127例,2级(较重骨髓水肿)68例。将疼痛程度分别与膝骨关节炎分度和骨髓水肿分级进行列联表资料字2检验及多个独立样本比较的秩和检验。结果疼痛程度与膝骨关节炎分度间无明显相关性(字2=5.251,P=0.263),但中重度疼痛组中重度骨关节炎的比例高于无疼痛组和轻度疼痛组(42.4%∶23.4%和24.5%)。疼痛程度与骨髓水肿分级间存在相关性(字2=28.175,P<0.001);虽然两疼痛组的骨髓水肿发生率之间的差异无统计学意义(字2=4.632,P=0.099),但中重度疼痛组的2级骨髓水肿的比例高于轻度疼痛组(42.4%∶27.2%)。秩和检验显示,三组疼痛病例的骨关节炎比例差异无统计学意义(P=0.152);而骨髓水肿的差异则有统计学意义(P<0.001),随疼痛程度的加重,骨髓水肿的程度也加重。结论膝骨关节炎疼痛与软骨下骨髓水肿相关,且存在疼痛越重,则骨髓水肿越严重的趋势;膝骨关节炎疼痛程度与病变的X线分级无关。
Objective To evaluate whether the presence of subchondral bone marrow edema （BME） in magnetic resonance imaging（MRI） are associated with the different levels of knee pain among the patients suffering osteoarthritis（OA）. Methods Based on rating scale of pain, 264 patients with knee OA were divided into three groups： 47 in the no pain group, 184 in the mild pain group, 33 in the moderate or severe pain group. Contingency table analyses and rank sum tests were used to compare the difference of OA stage and BME score among these groups. OA was classified by the X-ray as the Kellgren-Lawrence （K-L） scoring scale system： 52 mild（K-L Ⅱ degree）, 142 middle（K-L Ⅲ degree）, 70 severe（K-L Ⅳdegree）; while BME was identified from MRI： 69 with grade 0 （no BME）, 127 with grade 1 （small BME）, 68 with grade 2（large BME）. Results There were no statistical significance of OA stage among three pain groups （X2=5.251, P= 0.263）, though severe OA were more likely to occur in moderate or severe pain group as compared with the no pain and mild pain groups（42.4% vs 23.4% and 24.5%）. Also in the three groups, the prevalence of each score BME was of great significant difference （χ^2=28.157, P〈0.001）. BME was of no difference in the two groups of painful OA （χ^2=4.632, P=0.099）, but there was more large BME in moderate or severe pain group than in mild pain group （42.4% vs 27.2%）. The results of rank sum tests for several independent samples showed, no difference of OA （P=0.152） and significant difference of BME （P〈0.001） among three groups. With the advance of pain scale, the mean rank of BME increased gradually. Conclusion The finding on MRI of subchondral BME was associated with the presence or absence of knee pain. There seemed to be a tendency： the more severe the pain was, the more large the BME would be. OA stage defined by X-ray had no substantial relationship with pain scale.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2005年第11期682-686,共5页
Chinese Journal of Orthopaedics
关键词
骨关节炎
膝
疼痛
磁共振成像
Osteoarthritis, knee
Pain
Magnetic resonance imaging
