膝骨关节炎患者关节疼痛与软骨下骨髓水肿的相关性研究

摘要

Objective:To investigate the correlation between the knee pain and subchondral bone marrow edema (BME) in patients with knee osteoarthritis (KOA).Methods:A total of 70 patients with KOA,who were treated in First Hospital of Shijiazhuang from December 2012 to January 2016,were selected and underwent MRI examination.The patients were divided into observation group (n=56 with BME) and control group (n=14 without BME)according to whether or not BME.The BME score of the observation group was scored,and the observation group was further divided into 1 score group,2 scores group and 3 scores group according to the score of BME.The pain scores of all the patients were assessed by the variable returns to scale (VRS) and visual blur scale (VAS).The VRS classification and VAS scores were compared between the control group and the observation group,and the VRS classification and VAS scores of the 1 score group,the 2 scores group and the 3 scores group were compared.The correlation between BME scores and VRS classification and VAS score was analyzed.Results:The I grade proportion of VRS classification in the observation group was 17.86％,which was significantly lower than that(50％) in the control group of;the Ⅱ grade proportion was 64.29％,which was significantly higher than that(28.57％) the control group,the differences were statistically significant (P＜0.05).The VAS scores of the observation group were significantly higher than those of the control group,the difference was statistically significant (P＜0.05).There was significant difference in proportion of Ⅰ grade,Ⅱ grade and Ⅲ grade of the VRS classification among the three small groups of observation group (P＜0.05);the Ⅰ grade proportion of VRS classification in 1 score group was significantly higher than that in 2 scores group and 3 scores group;the Ⅱ grade proportion of VRS classification in 2 scores group was significantly higher than that of 1 score group and 3 scores group;the Ⅲ grade proportion of VRS classification was significantly higher than that of 1 score group and 2 scores group,the differences were statistically significant (P＜0.05).The difference of VAS scores among the three small groups in the observation group was statistically significant (P＜0.05);the VAS score of 3 scorns group was significantly higher than that of 1 score group and 2 scores group;the VAS score of 2 scores group was significantly higher than that of 1 score group,the differences were statistically significant (P＜0.05).Spearman analysis showed that BME scores was positively correlated with VRS classification and VAS score (P＜0.05).Conclusion:Most patients with KOA have BME,whose knee pain is more obvious,and the more severe the BME,the stronger the pain.%目的:探讨膝骨关节炎(KOA)患者关节疼痛与软骨下骨髓水肿(BME)的相关性.方法:选取2012年12月到2016年1月在我院接受治疗的KOA患者70例,所有患者均行MRI检查,并根据有无BME将其分为对照组和观察组,其中有BME的患者均纳入观察组,共56例,无BME的患者纳入对照组,共14例,对观察组的BME情况进行评分,并进一步根据BME得分情况将观察组分为1分组、2分组和3分组.采用主诉疼痛分级法(VRS)、视觉模糊评分(VAS)对所有患者进行疼痛评分.比较对照组和观察组的VRS分级、VAS评分,比较1分组、2分组和3分组的VRS分级、VAS评分,分析BME得分和VRS分级、VAS评分的相关性.结果:观察组的VRS分级的I级比例为17.86％,显著低于对照组的50.00％,Ⅱ级比例为64.29％,显著高于对照组的28.57％,差异均有统计学意义(P＜0.05);观察组的VAS评分显著高于对照组,差异有统计学意义(P＜0.05);观察组三个分组的VRS分级Ⅰ级、Ⅱ级、Ⅲ级比例整体比较差异有统计学意义(P＜0.05),1分组的VRS分级Ⅰ级比例显著高于2分组和3分组,2分组的VRS分级Ⅱ级比例显著高于1分组和3分组,3分组的VRS分级Ⅲ级比例显著高于1分组和2分组,差异均有统计学意义(P＜0.05);观察组三个分组的VAS评分整体比较差异有统计学意义(P＜0.05),3分组的VAS评分显著高于1分组和2分组,2分组的VAS评分显著高于1分组,差异均有统计学意义(P＜0.05);经Spearman统计分析显示BME得分和VRS分级、VAS评分呈正相关(P＜0.05).结论:大部分KOA患者存在BME,而有BME的KOA患者关节疼痛更加明显,且BME越严重疼痛感越强.