晚期膝骨关节炎的滑膜炎MRI厚度分级与滑膜病理相关性  

Correlation between grading of MRI-determined thickness and pathological scores of synovital membrane of synovitis in end-stage osteoarthritis

作　　者：陈宁杰 赵卉 郝风云 刘浩 Chen Ningjie;Zhao Hui;Hao Fengyun;Liu Hao(Department of Orthopaedics,Zibo Central Hospital,Binzhou Medical College,Zibo 255000,China;Department of Pathology,West Coast Hospital,Qingdao University Medical College,Qingdao 266000,China;Department of Radiology,Zibo Central Hospital,Binzhou Medical College,Zibo 255000,China)

机构地区：[1]滨州医学院附属淄博市中心医院骨科,淄博255000 [2]青岛大学医学院附属西海岸医院病理科,266000 [3]滨州医学院附属淄博市中心医院医学影像科,淄博255000

出　　处：《中华关节外科杂志（电子版）》2018年第5期653-661,共9页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：山东省医药卫生科技发展计划项目(2015ws0004)

摘　　要：目的滑膜炎在膝骨关节炎(OA)中常见,晚期膝OA患者MRI测定的滑膜厚度分级与滑膜病理评分间的关系,尚不明确。本研究目的是探讨晚期膝OA患者中二者间关系,从而明确滑膜炎的MRI厚度分级和病理评分,是否可应用于OA的治疗效果评价。方法本次研究选择符合晚期膝OA诊断标准Ahlback分级法中的4级和5级并排除其他疾病的住院手术患者31例,均接受:(1)MRI对内、外侧间沟和内、外侧髌上囊4个区域滑膜的厚度进行分级测定,根据厚度将滑膜炎程度分为0~3级;(2)观察部位滑膜的取样进行苏木素-伊红(HE)染色、病理学评分;(3)采用Pearson线性相关或Spearman秩相关分析滑膜厚度分级、病理评分间的相关性,以相关系数(rs)评价。结果晚期膝OA 4个观察部位滑膜的MRI厚度分级差异无统计学意义(F=0. 39,P> 0. 05); 4个观察部位滑膜的病理评分和病理指标差异无统计学意义(F=2. 146,P> 0. 05);晚期膝OA滑膜炎的MRI厚度分级与病理评分具有正相关(rs=0. 81、0. 56、0. 59和0. 52,P <0. 01);与病理学3项指标具有正相关(rs=0. 4、0. 47、0. 36,P <0. 05)。结论滑膜的MRI检查与滑膜病理具有较强相关性,因此滑膜MRI与病理检查可用于对滑膜炎敏感的OA治疗药物选择及晚期患者的治疗效果评价。Objective To further investigate if MRI findings or the microscopic characteristics of synovitis could be used as criteria for the indications of knee replacement.Methods Thirty-one patients with end-stage knee osteoarthritis(OA)who met the fourth and fifth grade of the Ahlback classification and excluded other diseases were selected and received the following examinations:(1)noninvasive MRI evaluation for grading the synovial thickness of the investigated sites(i.e.,medial and lateral parapatellar recesses,and medial and lateral suprapatellar pouches;synovitis was categorized into grade 0~3 on the basis of the thickness);(2)hematoxylin and eosin(HE)staining and pathological score grading of samples from the synovial membrane at each observed site;(3)Pearson’s linear test or Spearman rank test which was expressed as Spearman rank correlation(rs)was used to analyze the correlation between synovial thickness and pathological scores.Results Statistical analysis revealed no significant difference in MRI synovial thickness grade across the different regions of the knee.The mean pathological scores of the different regions showed no significant differences,neither did the mean pathological parameter scores(F=2.146,P>0.05).The grade of MRI-determined thickness of synovitis in patients with end-stage knee OA was positively correlated with the pathological scores(rs=0.81,0.56,0.59,0.52 respectively;P<0.01)and the three pathological parameters(rs=0.4,0.47,0.36;P<0.05).Conclusion There is positively correlation between the grades of MRI-determined thickness and pathological scores of synovial membrane in patients with end-stage knee OA combining synovitis,which can be used as drug selection reference of synovitis-sensitive OA patients and the criteria of therapeutic efficacy for knee joint replacement.

关 键 词：骨关节炎 磁共振成像 滑膜 病理学 

分 类 号：R684.3[医药卫生—骨科学] R686.7[医药卫生—外科学]