膝骨性关节炎影像评级与疼痛症状相关性△

Correlation between pain symptoms and radiographic grades in knee osteoarthritis

摘要:

［目的］探讨膝骨关节炎影像评级与疼痛症状的相关性。［方法］本院门诊膝骨关节炎患者 285 例纳入本研究，其中轻度疼痛 157 例，年龄 （55.01±7.95） 岁，病程平均 （3.59±1.81） 个月，重度疼痛 128 例，年龄 （51.94±9.25） 岁，病程 （5.87±2.50） 个月。分析疼痛症状与临床和影像分级指标的相关性。［结果］ 轻度疼痛组年龄显著大于重度疼痛组 （P<0.05）， 轻度疼痛组男性比率显著大于重度疼痛组（P<0.05），轻度疼痛组病程显著短于重度疼痛组（P<0.05），轻度疼痛组 HSS 评分显著高于重度疼痛组（P<0.05），轻度疼痛组膝内翻程度，包括 FTA 和 MPTA，显著轻于重度疼痛组（P<0.05），轻度疼痛组的 K/ L 评级显著重于重度疼痛组（P<0.05），轻度疼痛组的 BME 评级显著轻于重度疼痛组（P<0.05）。但是，两组在主要症状侧别和 BMI 的差异无统计学意义（P>0.05）。Spearman 相关分析表明：VAS 评分与 K/L 评级之间呈显著正相关（P<0.05），VAS 评分与 MRI 骨髓水肿 （bone marrow edema, BME） 评级之间呈显著正相关 （P<0.05）。K/L 评级与 BME 评级之间无相关性 （P>0.05）。 多元线性逐步回归表明：HSS 评分 （β=-0.746，P<0.001）、年龄 （β=-0.183，P<0.001） 与 VAS 评分呈正相关；K/L 评级 （β= 0.173，P<0.001）、BME（β=0.274，P<0.001）与 VAS 评分呈正相关。［结论］MRI 显示的 BME 与疼痛症状呈正相关。

Abstract:

[Objective] To explore the correlation between pain symptoms and imaging grades in knee osteoarthritis. [Methods] A total of 285 patents who visited in out-patient department for knee osteoarthritis in our hospital were included in this study. The patients aged from 44 to 61 years, including 107 males and 178 females, with the course of disease ranging from 2 to 8 months. The correlations between pain symptoms and clinical and imaging grading parameters were analyzed. [Results] The patients with mild pain were significantly elder (P＜0.05) , of male dominated (P＜0.05) , shorter course of disease (P＜0.05) , higher HSS score, less extent of genu in terms of femorotibial angle (FTA) and medial proximal tibial angle (MPTA), higher Kellgren-Lawrence (K-L) grade in X-ray films (P＜0.05) and lower bone mar- row edema (BME) grade on MRI than those with severe pain. However, there were no statistically significant differences in the main symp- tom side and body mass index (BMI) between the two groups (P＞0.05) . As results of Spearman correlation analysis, there was a significant- ly negative correlation between VAS score and K-L grade (P＜0.05) , whereas there was a significant positive correlation between VAS score and BME grade (P＜0.05) . There was no a correlation between K-L grade and BME grade (P＞0.05) . In term of multiple linear stepwise re- gression, the HSS (β=-0.736, P＜0.001) and the age (β=-0.123, P=0.002) were negatively correlated with VAS score. [Conclusion] The BME revealed by MRI has a positive correlation with pain symptoms.