膝骨关节炎软骨下骨髓水肿样及囊样病变与软骨病损的相关性研究

目的:探讨膝骨关节炎软骨下骨髓水肿样及囊样病变与关节软骨缺失的关系。方法:683例膝关节骨关节炎患者纳入研究,其中126例135个膝关节进行了随访,随访期限为12~30个月。采用半定量积分系统WORMS分析膝关节骨髓水肿样和囊样病变的分布及邻近关节软骨状况。以骨髓病变稳定组作为参照,采用逻辑回归分析同一分区软骨下骨髓病损与软骨缺损之间的关系。结果:不伴有明显关节软骨病损的各分区其软骨下骨质病变发生率有明显差异,以胫骨中部分区较高。随访对照研究显示骨髓病变与软骨病损具有明显相关性,新发骨髓病灶相较稳定病灶的局部关节软骨病损的风险更为明显(OR=3.9),基期及随访期未见骨髓病变的病例组软骨病损风险远小于病灶稳定不变组(OR=0.1)。结论:膝关节承重部位相对易于发生软骨下骨髓病损,软骨下骨髓水肿样病变及囊样变与同一区域软骨病损明显相关。

Relationship between Subchondral Bone Marrow Edema-like or Cyst-like Lesions and Cartilage Loss in Patients with Knee Osteoarthritis

Purpose:To study the changes in subchondral bone marrow edema-like lesions and subchondral cysts from baseline to 12~30 months follow-up,and to evaluate the relationship with the progressive risk of cartilage loss in the same subregions.Methods: The status of bone marrow lesions and cartilage were scored in the same subregions according to the WORMS system.Within the follow-up survey,the changes of bone marrow lesions and cartilage in the same subregions were compared.By using a stable lesions group as the reference,a logistic regression model was used to assess the association of changes in bone marrow lesions status with cartilage loss.Results: Seven hundred and six cases of knees were included at baseline,and 135 cases participated in the 12~30 months follow-up evaluation.Bone marrow lesions were more common in the central subregions of tibia.The adjusted odds ratios of cartilage loss in the same subregion at follow-up for the different groups were 3.9 for newly developing bone marrow lesions and 0.1 for subregions with no lesions at baseline and follow-up.Conclusion: Bone marrow lesions are more common in load bearing subregions.Bone marrow edema-like lesions and subchondral cysts are associated with subregional cartilage loss.