膝骨关节炎膝痛分布及其与影像学特征的关系研究  

Clinical Study on Knee Pain Location and Its Association with Imaging

作　　者：陈元川[1,2] 庞坚[1,2] 石印玉[1,2] 詹红生[1,2] 曹月龙[1,2] 高宁阳[1,2] 李志强[1,2] CHEN Yuanchuan;PANG Jian;SHI Yinyu;ZHAN Hongsheng;CAO Yuelong;GAO Ningyang;LI Zhiqiang(Shi＇s Center of Orthopedics and Traumatology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Institute of Traumatology ＆ Orthopedics, Shanghai Academy of Traditional Chinese Medicine,Shanghai 201203 ,China.)

机构地区：[1]上海中医药大学附属曙光医院石氏伤科医学中心,上海201203 [2]上海市中医药研究院骨伤科研究所

出　　处：《中国中医骨伤科杂志》2018年第5期39-43,48,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：“中医骨伤科学”国家重点学科(100508);上海领军人才项目(041);国家自然科学基金面上项目(81674003);上海市卫生和计划生育委员会中医药科研专项(2016LZ001)

摘　　要：目的:疼痛是人类的第五大生命体征,膝痛是膝骨关节炎患者到医院就诊的主要原因和主诉。而对于膝痛的直接描述尚不完善,本研究提出了一种新方法 CKPM(Chinese Knee Pain Map),以期能够更直接有效的描述膝痛。方法:通过对300例患膝的研究,观察KPM疼痛类型和经筋病证类型的特点,并结合X线K-L分级、MRI半定量评估(WORMS法)以及WOMAC的临床症情描述法分析两者与这些指标间的相关性以及两者间的相关性,验证CKPM的有效性和可靠性的同时提出常见的KPM疼痛以及经筋分布类型。结果:膝痛KPM疼痛类型出现频率依次为混合性疼痛,占38.44%;复合性疼痛,占34.01%;单关节痛,占27.55%.经筋病证类型依次为两经筋病变124例,占42.18%、多经筋病变110例,占37.41%和单经筋病变60例,占20.41%、KPM疼痛类型与经筋病证类型呈一致性,与KL分级、MRI半定量评估(WORMS法)以及WOMAC临床症情改变情况呈正相关。结论:在膝骨关节炎中CKPM疼痛类型较复杂的或者说疼痛范围较大的其临床表现(包括临床症状和影像学表现)相对较重。CKPM可以作为膝骨关节炎诊疗评估的有效的、可靠的一种手段。Objective：Pain is called the fifth vital signs.And knee pain is the main reason and the most frequent complain for patients to go to hospitals.In order to assess the severity of knee osteoarthritis directly and completely,this research raised a method,called Chinese Knee Pain Map,CKPM.Method：300 knees were observed though knee pain map combined with Jingjin patterns,named CKPM.The correlation between KPM and the Jingjin patterns was analyzed.Then,CKPM was compared with X-ray K-L scores,MRI based semiquantitative scores（WORMS）,and clinical symptoms（WOMAC scores）by correlation analysis.We conclude the common patterns of KPM（knee pain map）and Jingjin,meanwhile,the reliability and validity of the CKPM were verified in this part.Results：The most frequent appeared KPM patterns are mixed ones（38.44%）,combined ones（34.01%）and single（27.55%）joint ones.The Multiple Jingjin patterns occupied 37.41 percent with 110 knees,the percentages of the dual Jingjin patterns is 42.18% with 124 knees and that of single Jingjin is 20.41% with 60 knees.CKPM has a positive correlation with K-L scores,MRI based semiquantitative scores（WORMS）and WOMAC scores.Conclusion：In knee osteoarthritis patients,CKPM pain patterns have a positive correlation with X-ray K-L scores; MRI based semiquantitative scores,WORMS,and WOMAC scores.More complicated patterns means more severity of the disease.CKPM could be a reliable and valuable method to assess knee osteoarthritis.

关 键 词：疼痛 膝骨关节炎 膝痛图谱 从筋论治 中医药 

分 类 号：R684.3[医药卫生—骨科学]