同种异体半月板移植和半月板切除术后中期临床效果比较

目的:比较同种异体半月板移植和半月板切除术后中期临床效果。方法:2005年6月至2009年8月,16例半月板切除术后患者接受18个同种异体半月板移植(移植组),其中男12例,女6例,年龄25.7±7.9岁。以同期行半月板切除术的20例患者为对照(切除组),其中男12例,女8例,年龄25.0±7.2岁。采用IKDC评分、Lysholom评分、Tegner评分、VAS评分等比较两组患者临床效果,并通过X线、核磁共振成像(MRI)比较两组患者膝关节退变和软骨损伤进展情况。结果:两组平均随访时间分别为60±20、54.4±6.1个月,术前IKDC评分、Lysholom评分、Tegner评分、VAS评分无显著性差异。术后两组患者的临床评分、单腿跳、关节间隙变化和力线等无显著性差异。切除组Kellgren-Laurence分级术后与术前的差值为1.4(1~2),明显高于移植组的0.3(0~1)(P<0.05)。移植组术后MRI软骨分级和软骨损伤进展程度均明显低于切除组,分别为1.2(0~3)vs 2.0(1~3)(P=0.028),0.7(0~2)vs 1.4(0~2)(P=0.001)。结论:半月板移植术后中期临床效果良好,与半月板切除无明显差异;半月板移植具有保护软骨、减缓关节退变的作用。     

膝关节骨关节炎软骨磁共振研究

目的:研究膝骨关节炎(OA)的软骨磁共振表现(MRI),评估软骨MR成像对于OA诊疗评估的意义.方法:对56例40～70周岁确诊膝关节OA病例和45例无症状志愿者行X线检查并进行K-L评分后实施软骨MR成像:①快速自旋回波T2加权成像(FSE T2 WI);②三维脂肪抑制扰相梯度回波序列(3D-FS-SPGR)并采用最大信号强度法(MIP)进行三维重建;③脂肪抑制质子加权序列(Fs-PD).分别比较:①软骨平均厚度;②软骨缺损分布区域并进行直径测量和Noyes分级;③软骨下骨质水肿表现,并统计分析两组磁共振表现差异.结果:①OA病例组膝关节X线平片K-L积分显著高于病例组(Z=-5.39481,P<0.001);②病例组膝关节软骨整体厚度显著低于对照组(P<0.001);③病例组膝关节软骨缺损所涉及的关节面区域多于对照组(Z=-6.23,P<0.001);软骨缺损的Noyes分级水平(Z=-8.336,P<0.001)和软骨缺损直径(Z=-8.42,P<0.001)也大于对照组.④病例组膝关节出现不同程度的软骨下骨质水肿,而对照组所有膝关节均没有出现软骨下骨质异常信号.结论:40～70岁OA患者的膝关节软骨相对同年龄无症状人群显著变薄,且软骨缺损程度大.结合合适的评价系统,软骨磁共振成像可以有效地应用于OA临床诊断和治疗评估.     

磁共振膝关节骨关节炎MOAKS评分在中国人群中的应用

目的验证半定量膝关节骨关节炎(KOA)MRI评分系统MOAKS在中国人中的观察者内及观察者间一致性,分析其与WOMAC OA指数的相关性,探讨MOAKS在中国人群中的应用。资料与方法对55例KOA患者行膝关节MRI扫描,在膝关节各亚区内对关节软骨损伤、骨髓损伤、骨赘、滑膜炎、关节内渗出、半月板损伤、韧带损伤及其他关节周围异常征象进行MOAKS评分,对患者进行WOMAC OA指数评分,分析观察者内和观察者间对MOAKS评分的一致性,分析MOAKS评分与WOMAC OA指数的相关性,并与16例手术患者的损伤程度进行比较。结果 55例患者均检出不同程度的软骨损伤、骨髓水肿和(或)骨赘形成。观察者内与观察者间对软骨缺损、骨赘、半月板损伤、渗出、韧带损伤的MOAKS评分一致性好(Kappa>0.75);MOAKS总分与WOMAC中的疼痛、功能障碍评分及总分呈正相关(r=0.761、0.606、0.702,P<0.01),骨髓损伤与疼痛的相关性最高(r=0.838,P<0.01);MOAKS评分高低与手术观察到的关节面损伤程度相符合。结论 MOAKS在中国人中应用可以综合评估KOA的特征,其评分高低可以反映临床症状、关节面损伤程度,可以作为骨关节炎疾病研究和评估的重要工具之一。     

强直性脊柱炎骶髂关节骨髓水肿SPARCC评分的临床应用研究

目的:探讨强直性脊柱炎(ankylosing spondylitis,AS)骶髂关节骨髓水肿加拿大脊柱骨关节研究协会评分系统(SPARCC)的临床应用价值。方法:收集45例临床确诊的AS患者,依据Bath强直性脊柱炎疾病活动指数(Bath ankylosing spondylitis disease activity index,BASDAI)评估病情的活动性。患者行骶髂关节MRI及CT扫描,依据SPARCC对AS骶髂关节骨髓水肿程度进行评分,分析骨髓水肿SPARCC评分与病情活动性BASDAI评分的相关性。病情进展程度依据AS骶髂关节CT表现分级,分为早期(0^Ⅱ级)和中晚期(ⅢⅡ级)和中晚期(Ⅲ^Ⅳ级)2组,比较2组骨髓水肿SPARCC评分差异。结果:骨髓水肿SPARCC评分与病情活动BASDAI评分呈正相关(rs=0.645,P<0.05),不同病情进展程度2组间骨髓水肿SPARCC评分差异无统计学意义(P>0.05)。结论:AS骶髂关节骨髓水肿SPARCC评分作为判定病情活动性的依据,可有效、全程监测AS患者病情活动。     

3.0 T MRI与X线平片上分别测量膝关节间隙宽度的对比研究

目的 研究3.0 T MRI各向同性梯度回波序列用于测量正常人及不同程度骨性关节炎(0A)患者关节间隙的可行性.方法 选取正常志愿者,轻度OA患者(Kellgren-Lawrence分级1～2级)及重度OA患者(Kellgren-Lawrence分级3～4级)各30例,各30个膝关节,分别采用Philips DR和Siemens 3.0 T MR进行检查.由两名观察者分别在3.0TMR采用各向同性快速小角度激发成像(FLASH)梯度回波序列三维重组冠状位像上和X线平片上测量膝关节间隙,并采用t检验观察两名观察者间在MRI上的测量差异.然后对三组受试对象的X线与MRI检测结果及在MRI及平片上测得组组间的数据运用t检验分别行统计学差异比较.结果 在3.0T MR各向同性FLASH梯度回波序列三维重组冠状位像上测量正常人膝关节间隙,与在X线平片上测量的关节间隙在两名观察者间可重复性较高;对志愿者组、轻度OA组及重度OA组测得的内外侧胫股关节间隙宽度,在MRI与X线平片之间无统计学差异(志愿者组内侧胫股关节间隙t=0.53,P=0.60,外侧t=0.11,P=0.91;轻度OA组内侧胫股关节间隙t =0.25,P=0.80,外侧t=0.07,P=0.94;重度OA组内侧胫股关节间隙t=0.09,P=0.93,外侧t=0.11,P=0.91);志愿者组与轻度OA组间及轻度OA组与重度OA组间在MRI上测量的内外侧胫股关节间隙宽度有统计学差异(志愿者组与轻度OA组间内侧胫股关节间隙t=2.71,P＜0.01,外侧t=2.95,P＜0.01;轻度OA组与重度OA组间内侧胫股关节间隙t =3.77,P＜0.01,外侧t=1.93,P＜0.01).结论 使用MRI可以准确测量正常及不同程度OA患者的关节间隙宽度,MRI测量关节间隙的有效性与平片一致.     

膝类风湿关节炎的MRI与病理对照研究

目的通过对膝类风湿关节炎(RA)病人关节软骨、软骨下骨髓及半月板进行MR-病理对照分析,探讨膝RA的MRI特点及病变发生机制。方法收集我院2008年11月—2014年12月间确诊为膝RA并行全膝关节置换术的11例病人(共13只膝关节)资料。评价关节软骨、软骨下骨髓及半月板的MRI表现,并在显微镜下对观察膝RA病人膝关节各部位组织的病理学特点。当细胞成分不确定时,使用免疫组织化学方法确定细胞种类。对关节软骨损伤MRI分级和半月板损伤MRI分度以及不同部位关节软骨下骨髓水肿和关节软骨、半月板损伤的病理学表现分度进行分析,并采用Mann-Whitney U检验对位于裸区和远离裸区的软骨下骨髓水肿的病理学表现分度进行比较。结果本组膝RA病人中大部分病人的MRI关节软骨破坏程度为4级,半月板破坏程度为4度。MRI显示52处软骨下骨髓水肿的部位中有18处(34.6%)于骨髓水肿上方覆盖有关节软骨且远离裸区,而34处(65.4%)的骨髓水肿位于裸区且邻近滑膜。在软骨下骨髓水肿的病理学表现中,纤维化、骨小梁镶嵌样结构及淋巴细胞浸润为最常见的表现。位于裸区和远离裸区骨髓水肿的两组间各种病理学表现分度差异均无统计学意义(均P0.05)。在关节软骨破坏的病理学表现中,纤维环、关节软骨破坏变薄及关节软骨增生为最常见的镜下病理表现。在全部13只切除的膝关节共26个半月板标本中,仅发现5个(19.2%)残留半月板标本,在MRI上均表现为萎缩、变薄,信号不均,其最常见的病理学表现为纤维化和吞噬包裹钙化碎片。结论晚期膝RA病人半月板及关节软骨破坏严重,骨髓水肿可发生于关节裸区或远离裸区部位,提示膝RA可同时累及多个部位,导致病人关节功能严重减退甚至丧失。     

MRI联合CT对类风湿性关节炎骨质侵蚀程度检测与预后的相关性

目的探讨骨髓水肿和骨侵蚀对类风湿性关节炎(RA)疗效观察的价值,以及与预后的关系。方法选取确诊的类风湿患者34例,于治疗前进行腕关节的MRI、CT检查,检查范围包括双侧腕关节和第2~5掌指关节,所有患者确诊后均进行正规类风湿治疗,间隔6个月后对患者进行MRI、CT随访观察,参照OMERACT RAMRIS评分系统和X线简易狭窄侵蚀评分(simple erosion narrowing score,SENS)对RA骨髓水肿(bone marrow edema,BME)、骨侵蚀进行评分,分析治疗有效组和无效组之间各征象治疗前后评分差异,以及各征象相关性。结果 MRI的BME评分和骨侵蚀评分、SENS评分、治疗效果有显著相关性(r=0.919,P=0.000;r=0.884,P=0.000;r=0.493,P=0.003),治疗效果和MRI骨侵蚀评分、SENS评分显著相关(r=0.487,P=0.004;r=0.509,P=0.002)。有效组和无效组MRI骨髓水肿治疗前后评分变化值差异有统计学意义,有效组平均变化值10.0±5.9,无效组0.9±10.5,(Mann-Whitney Test,P=0.003),ROC曲线下面积为0.836,P=0.003,治疗前后评分差值≥6.5为治疗有效标准,敏感度为80%,特异度为77.8%;有效组和无效组MRI骨侵蚀评分和SENS评分治疗前后评分变化值差异无统计学意义(Mann-Whitney Test,P=0.679;P=0.055)。结论 MRI联合CT检查可半定量反映患者骨侵蚀和关节破坏程度,MRI水肿评分与骨侵蚀程度显著相关,可为预后判断提供帮助。MRI骨髓水肿作为临床疗效观察的指标,具有较高的特异度和敏感度。     

椎体压缩性骨折MRI信号特点与PVP术后疗效相关性分析

目的分析骨质疏松性椎体压缩骨折(OVCF)术前MRI信号特点及比较经皮椎体成形术(PVP)术前、术后疼痛状及功能障碍改善情况,以探索OVCF的MRI信号特点和PVP疗效的相关性。方法回顾性分析52例患者,116节椎体PVP治疗的临床及影像学资料。术前及术后进行视觉模拟疼痛评分(VAS)及Oswesty功能障碍指数评价,并观察其并发症情况。根据MRI骨髓水肿的程度和范围将其分为部分骨髓水肿(A组)、完全骨髓水肿(B组)和无骨髓水肿(C组),然后比较3组术前、术后疼痛和功能障碍情况。结果 3组间术前VAS差异无统计学意义(P>0.05),术后疼痛缓解程度及功能改善程度差异有统计学意义(P<0.05)。A、B组与C组比较疼痛缓解明显,B组比A组疼痛缓解程度大,表明骨髓水肿范围越大,PVP治疗后疼痛缓解程度越大。结论 PVP是治疗OVCF的有效方法,MRI信号特点对于OVCF治疗效果有一定的预测价值,有骨髓水肿比无骨髓水肿治疗效果好,且水肿范围越大,PVP治疗后疼痛缓解程度越大。     

膝内侧半月板后角根部撕裂伴移位的临床及影像分析

【摘要】目的：探讨膝关节内侧半月板后角根部撕裂（MMPRT）伴移位的相关因素及伴发损伤。方法：回顾性分析经关节镜证实的42例膝内侧半月板后角根部撕裂患者的临床资料及MRI特征,根据撕裂后移位程度将患者分为移位组（撕裂间隙≥1.0mm）和非移位组（撕裂间隙<1.0mm）。对患者的性别、年龄、体重、体重指数、半月板绝对脱出量和相对脱出率、关节软骨损伤、骨髓水肿及关节积液等相关特征进行分析。结果：移位组半月板绝对脱出量显著高于非移位组［(4.3±0.9) vs. (3.3±0.9)mm,P<0.01］。移位组半月板相对脱出率明显高于非移位组［(32.3%±11.6%) vs. (20.1%±5.0%),P<0.01］。移位组内侧胫骨平台软骨损伤程度较非移位组严重（P=0.03）。而两组患者的性别、年龄、体重、体重指数及骨髓水肿和关节积液程度的差异无统计学意义（P＞0.05）。结论：在内侧半月板后角根部撕裂中,较大的撕裂间隙使半月板脱出更明显,内侧胫骨平台软骨损伤程度更严重,加剧了骨关节炎的进展。     

多间室和内侧单间室严重骨关节炎内侧半月板突出及后根撕裂的特点分析

目的：探究多间室和内侧单间室严重骨关节炎（OA）患者内侧半月板突出（MME）及内侧半月板后根撕裂（MMPRT）的特点。方法：回顾性分析2020年6月至2021年11月我科收治的117例终末期OA患者的基线资料、X线和磁共振（MRI）图像,其中多间室严重OA患者60例67膝（M-OA组）,均行全膝关节置换;内侧单间室严重OA患者57例68膝（mU-OA组）,均行内侧单髁置换。在MRI上测量患膝MME程度,判定是否存在MMPRT,并在X线片上测量髋膝踝角（HKA）、胫骨近端内侧角（MPTA）、机械轴股骨远端外侧角（mLDFA）、胫股关节线夹角（JLCA）,在MRI上测量内侧胫骨平台后倾角（mPTS）。对基线资料、病理性MME和MMPRT发生率、MME程度、HKA、MPTA、mLDFA、JLCA和m PTS进行统计学分析。结果：两组患者年龄、体质指数（BMI）和患膝侧别等无显著性差异（P>0.05）,M-OA组患者女性比例高于mU-OA组（78.33%vs 56.14%,P<0.05）。M-OA组病理性MME发生率高于m U-OA组（79.1%vs52.94%,P<0.01...     

股四头肌脂肪垫和股前脂肪垫形态和信号特征与膝关节骨性关节炎的相关性研究

目的:探讨股四头肌脂肪垫(QFP)和股前脂肪垫(PFP)的形态和信号特征与膝关节放射学骨性关节炎(ROA)结构改变的关系.方法:回顾性分析纳入的60个临床资料齐全的膝关节X线和MRI检查图像资料,于矢状面PDW-SPAIR序列图像上定量测量QFP最大前后径、最大头尾径、最大斜径和最大面积及PFP的最大厚度.半定量评估Q...     

The association of meniscal body height with knee structural changes in middle-aged and elderly patients with symptomatic knee osteoarthritis

Objectives:To investigate whether and how meniscal height is associated with osteoarthritis (OA)-related knee structural changes in symptomatic knee OA.Methods:We studied 106 patients (61 female, aged 40–73 years) with symptomatic knee OA. X-ray was used for Kellgren-Lawrence score. Meniscal body heights and extrusion were measured on coronal sections of intermediate-weighted MRI sequence. Knee structural changes were assessed using the modified whole-organ magnetic resonance imaging score (WORMS). Associations between meniscal body height and knee structural changes were assessed using linear regression analysis.Results:Higher medial meniscal body height was significantly associated with severe medial meniscal lesions (p = 0.001–0.023), medial compartmental cartilage lesions (p = 0.045), patellofemoral compartmental and medial compartmental bone marrow edema patterns (p = 0.001–0.037), anterior cruciate ligament and patellar ligament abnormalities (p = 0.020–0.023), and loose bodies (p = 0.017). However, lateral meniscal body height was negatively correlated with WORMS scores for lateral meniscal lesions (p ≤ 0.018), lateral compartmental cartilage lesions (p ≤ 0.011), and lateral compartmental bone marrow edema patterns (p = 0.038).Conclusion:Higher medial meniscal body height was associated with more severe medial compartment structural abnormalities and patellofemoral bone marrow edema patterns, while lateral meniscal body height was inversely correlated with the severity of lateral compartment structural abnormalities.Advances in knowledge:Our study revealed that meniscal body height was associated with multiple OA-related knee structural changes, which would be beneficial in identifying patients with or at risks for knee OA.     

Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up

OBJECTIVE: The purpose of this study was to determine if a correlation exists between magnetic resonance imaging (MRI) findings of bone marrow edema (BME) in osteoarthrosis (OA) of the knee joint and need for total knee arthroplasty (TKA) within a follow-up period of 3 years. MATERIALS AND METHODS: The entire database of knee MR studies over a 3-year period was used to select individuals with knee OA. A chart review was conducted to identify and include only those who had a 3-year follow-up appointment from the time of the initial MR study. There were 25 patients in the OA-only group (four men and 21 women; age range, 28-75; average age, 49.3 years). The OA and BME group had 48 patients (23 men and 25 women; average age, 55.5 years). The MRs were reviewed and interpreted by a musculoskeletal radiologist and were classified into one of four patterns of BME: none, focal, global, or cystic pattern. Meniscal tear and degree of cartilage loss were also assessed. RESULTS: Subjects who had BME of any pattern type were 8.95 times as likely to progress rapidly to a TKA when compared to subjects with no BME (p = 0.016). Subjects with a global pattern of BME were 5.45 times as likely to have a TKA compared to subjects with focal, cyst, or no BME (p < 0.05). Subjects with a global edema pattern were 13.04 times as likely to have a TKA than subjects with no marrow edema in the knee (p < 0.01). There was no correlation of TKA with meniscal tear or cartilage loss. The group of subjects who had a TKA were 12.6 years older than those who did not have a TKA (p < 0.001). However, the BME results were still significant after accounting for the age difference. CONCLUSION: Our classification of patterns into global, focal, cystic, and absence of BME is an attempt to further define edema in osteoarthrosis and how it relates to clinical progression. Patients with BME and OA have an increased risk of TKA as opposed to OA and no marrow edema. The BME pattern with the worst prognosis for the knee is the global pattern.     

痛风性膝关节炎MRI骨侵蚀、骨髓水肿、滑膜炎与痛风石的相关性研究

目的探讨膝关节痛风性关节炎MRI特征,及骨侵蚀、骨髓水肿、滑膜炎与痛风石之间的相互关系,以研究痛风骨侵蚀和关节损伤的潜在机制。方法回顾性分析31例慢性痛风患者膝关节双能量CT和MRI影像检查,对比分析痛风石、骨髓水肿、骨侵蚀及滑膜炎之间的相关关系。结果4例患者为双侧膝关节检查,共35个膝关节纳入研究,其中34%的存在骨侵蚀,与痛风石有明显相关性,OR值76.4(95%CI 10.0,582.2)(P<0.001)。骨髓水肿不常见,发生率仅为1.2%(3/245),骨侵蚀和骨髓水肿之间没有明显相关性。在有骨侵蚀的膝关节中,75%的膝关节同时伴有滑膜炎,而在没有骨侵蚀的膝关节,43.4%的膝关节具有滑膜炎,骨侵蚀和滑膜炎之间的OR值为5.3(95%CI 1.1,25.5)(P=0.035)。结论痛风性关节炎骨侵蚀,与痛风石沉积明显相关;痛风骨髓水肿不常见,且水肿程度轻微。痛风石是骨侵蚀发生的主要危险因素之一。     

Percutaneous vertebroplasty: relationship between vertebral body bone marrow edema pattern on MR images and initial clinical response

Purpose: To prospectively investigate the relationship between initial clinical response and bone marrow edema pattern on preprocedural magnetic resonance (MR) images in vertebral bodies selected for percutaneous vertebroplasty (PVP). Materials and Methods: Institutional review board approval and written informed consent were obtained. PVP was performed for osteoporotic compression fractures in 80 consecutive patients (mean age, 72.4 years; range, 44-85 years; 67 women and 14 men; 157 vertebrae). Patients were divided into three groups according to the proportion of the vertebra in which the bone marrow edema pattern was observed on sagittal MR images: group 1, 50% or more of the vertebra; group 2, less than 50%; group 3, no edema pattern observed. By using Wilcoxon rank sum test, Fisher exact test, and Wilcoxon signed rank test, groups were examined for differences in treatment efficacy, which was defined as the difference between preprocedural and postprocedural pain as assessed by means of visual analog scale (VAS) score at 1-3 days after PVP. Results: Forty-four patients were assigned to group 1, 14 to group 2, and 22 to group 3. No significant difference was seen between the groups with respect to age, sex, number of treated vertebrae, or preprocedural VAS score. In group 1, VAS score decreased from 7.5 before the procedure to 2.9 after (improvement of 4.6). In group 2, the score decreased from 6.8 to 3.1 (improvement of 3.7). In group 3, the score decreased from 7.0 to 4.3 (improvement of 2.7). Improvement was significantly greater in group 1 than in group 3 (P < .005). Conclusion: PVP resulted in significantly greater clinical improvement in patients with an extensive bone marrow edema pattern than in those without this pattern. (c) RSNA, 2006.     

He-Ne激光联合超短波疗法、股四头肌训练治疗膝关节骨关节炎的临床观察

目的观察He-Ne激光联合超短波、股四头肌训练治疗膝关节骨关节炎（knee osteoarthritis,KOA）的疗效。方法膝关节OA患者80例,分为两组,每组40例患者。对照组,采用超短波联合股四头肌功能训练治疗;激光组,采用HeNe激光联合超短波、股四头肌功能训练治疗,对照组和治疗组均治疗50 d。两组患者治疗前、后分别采用视觉模拟评分（visual analogue scale,VAS）评价疼痛和Lysholm功能评分量表（Lysholm knee scoring scale,LKSS）进行疗效评定。结果两组患者治疗后VAS疼痛评分和Lysholm膝关节评分均较治疗前好转,有显著性差异（P〈0.01）,两组治疗后组间比较,激光组的VAS疼痛评分低于对照组,差异有显著性意义（P〈0.01）;激光组的Lysholm膝关节评分高于对照组,差异有显著性意义（P〈0.01）。结论 He-Ne激光联合超短波疗法、股四头肌训练治疗对改善患者的膝骨关节功能、缓解关节疼痛优于单纯超短波联合股四头肌训练治疗。     

MR imaging findings in the follow-up of patients with different stages of knee osteoarthritis and the correlation with clinical symptoms

Objective: To assess the rate of cartilage loss, the change in bone marrow edema pattern and internal joint derangement at 1.5-T MRI in patients with knee osteoarthritis and to correlate these findings with the clinical Western Ontario and McMaster University Osteoarthitis (WOMAC) score. Methods: Forty subjects (mean age 57.7±15 years; 16 females and 24 males) were recruited: 6 healthy volunteers (OA0), 17 patients with mild osteoarthritis (OA1) and 17 with severe osteoarthritis (OA2) based on the Kellgren-Lawrence scale. MR scans, radiographs and WOMAC scores were obtained at baseline, first follow-up (1.4±0.67 years; n=40) and second follow-up (2.4±0.4 years; n=26). Cartilage morphology, bone marrow edema (BME), meniscal and ligamentous pathology were assessed on MR images and quantified by two radiologists in consensus. Results:Full-thickness cartilage lesions were observed in 12/17 OA2 at baseline, in 13/17 at the first follow-up and in 7/10 at the second follow-up. Cartilage loss was found in eight patients at the first follow-up and five at the second follow-up. BME was observed in 23/40 patients at baseline, in 22/40 at the first follow-up and in 12/26 at the second follow-up. Changes in BME were visualized in 19/22 and 4/13 patients at the first and second follow-up, respectively. Changes in WOMAC scores over time did not correlate significantly with the amount of cartilage loss and the change in BME (P>0.05). Conclusion:MRI is well suited to monitor the progression of OA in the longitudinal follow-up since it shows cartilage defects, BME and internal joint derangement, pathologies that are not visualized by radiographs. The lack of significant correlation between MRI findings and clinical findings is not unexpected, has been previously described and may in part be due to the fact that patients get more accustomed to their pain as the knee progressively degenerates.     

髋部骨髓水肿综合征的临床影像学分析

目的探讨髋部骨髓水肿综合征(bone marrow edema syndrome)的临床和影像学表现及其诊断价值。资料与方法回顾性分析7例经临床和MRI随访诊断的髋部骨髓水肿综合征患者的临床和影像学资料,其中男3例,女4例,包括7例MRI检查和5例X线平片检查,同时随访3~7个月。结果 7例患者因无明显诱因出现单侧髋部症状就诊,MRI上均表现为股骨近段较广泛的骨髓水肿信号,其中3例X线平片表现为相应部位的骨质疏松。所有患者保守对症治疗后3~7个月随访,临床症状消失,MRI上骨髓水肿信号消失,但其中1例对侧髋部又出现新的类似病变。结论掌握此病的临床和影像学表现,有助于正确诊断。     

A prospective study on MRI findings and prognostic factors in athletes with MTSS

In medial tibial stress syndrome (MTSS) bone marrow and periosteal edema of the tibia on the magnetic resonance imaging (MRI) is frequently reported. The relationship between these MRI findings and recovery has not been previously studied. This prospective study describes MRI findings of 52 athletes with MTSS. Baseline characteristics were recorded and recovery was related to these parameters and MRI findings to examine for prognostic factors. Results showed that 43.5% of the symptomatic legs showed bone marrow or periosteal edema. Absence of periosteal and bone marrow edema on MRI was associated with longer recovery (P = 0.033 and P = 0.013). A clinical scoring system for sports activity (SARS score) was significantly higher in the presence of bone marrow edema (P = 0.027). When clinical scoring systems (SARS score and the Lower Extremity Functional Scale) were combined in a model, time to recovery could be predicted substantially (explaining 54% of variance, P = 0.006). In conclusion, in athletes with MTSS, bone marrow or periosteal edema is seen on MRI in 43,5% of the symptomatic legs. Furthermore, periosteal and bone marrow edema on MRI and clinical scoring systems are prognostic factors. Future studies should focus on MRI findings in symptomatic MTSS and compare these with a matched control group.