基于磁共振软骨影像的膝骨关节炎关节镜疗效评估  

Arthroscopic curative effect evaluation of elderly degenerative knee osteoarthritis with magnetic resonance cartilage imaging

作　　者：张海东 滕涛[2] 刘俊英[2] 郭艾[1] 张洪瑞 陈阳[2] 肖斌[2] 王凯伦 Zhang Haidong;Teng Tao;Liu Junying;Guo Ai;Zhang Hongrui;Chen Yang;Xiao Bin;Wang Kailun(Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;Department of Orthopedic, Beijingshi Puren Hospital, Beijing 100062, China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,100050 [2]北京市普仁医院骨科,100062

出　　处：《中华关节外科杂志（电子版）》2021年第6期666-672,共7页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的结合术前磁共振(MRI)软骨影像分级系统,分析膝骨关节炎(OA)关节镜手术疗效。方法对91例行关节镜手术的老年膝骨关节炎患者进行回顾分析,其中男25例,女66例;年龄60~85岁,选取符合膝骨关节炎诊断标准、术前影像资料齐全、X线Kellgren-Lawrence(K-L)分级0~Ⅲ级、且接受单纯关节镜治疗、术后可进行随访的60岁以上的患者,排除非单纯关节镜治疗、影像资料不全和术后无法进行随访的患者。对所有患者术后随访,根据疗效持续时间,分成有效组和无效组。术前及术后均行膝关节创伤与骨关节炎评分(KOOS),分析患者年龄、术前X线K-L分级、MRI软骨全器官磁共振评分法(WORMS分级)和疗效持续时间的相关性。组内比较采取配对样本t检验,组间比较采取协方差分析,相关性分析采用Spearman相关分析、多元线性回归分析。结果91例患者91个膝关节,平均(69.3±6.3)岁;有效患者32例,其中K-LⅡ级32例,WORMS分级2.5级1例,3级15例,4级16例;无效患者59例,其中K-LⅡ级31例,K-LⅢ级28例,WORMS 4级10例,WORMS 5级29例,WORMS 6级20例。患者KOOS术后5项评分均高于术前,其中有效组术后KOOS评分较无效组提高明显。术后评分的单因素协方差分析显示,两组术后评分改变差异均有统计学意义(F=134.813,56.785,138.996,28.502,58.799,均为P<0.001),有效组术后评分明显高于无效组。多元线性回归分析示MRI分级对术后疗效持续时间影响具有统计学意义(t=-12.526,P<0.001)。MRI分级与术后疗效时间相关性更高(r=-0.927,P<0.001)。生存曲线示随着MRI分级的增加,术后疗效时间变短(χ^(2)=111.0,P<0.001)。结论结合软骨WORMS分级,有助于鉴别老年早期膝骨关节炎患者,通过关节镜姑息+骨髓刺激术,可有效缓解症状,值得临床推广应用。Objective To investigate the correlation between X-ray and preoperative magnetic resonance imaging(MRI)cartilage grading in patients with degenerative knee osteoarthritis(OA)after arthroscopic surgery.Methods A total of 91 cases of elder patients with knee OA underwent arthroscopic surgery were retrospectively reviewed,including 25 males and 66 females.The patients aged from 60 to 85 years who met the diagnostic criteria for knee osteoarthritis with complete preoperative imaging data(X-ray and MRI),Kellgren-Lawrence(K-L)grade zero toⅢ,received arthroscopy alone,and could be followed up after surgery were selected.The patients who underwent arthroscopy combined with other treatment,image data incomplete,and could not be followed-up were excluded.According to the postoperative curative effect duration,the patients were divided into the effective group and the invalid group.All the patients were followed-up for 24 months.The preoperative and postoperative knee injury&osteoarthritis score(KOOS)were evaluated.Knee images of preoperative X-ray and MRI classification were retrospectively analysed,including K-L grades of X-ray,the whole-organ magnetic resonance imaging score(WORMS)of MRI.The correlation of preoperative imaging classification(K-L grades and WORMS)and the duration of curative effect were analysed.Student t test,covariance analysis and Spearman correlation analysis were used for differences analysis in the groups and between the groups;correlation was analyzed by multiple linear regression analysis.Results Among 91 patients with 91 knee joints,the average age was(69.3±6.3)years,the effective group were 32 patients of K-L gradeⅡ,one patient with WORMS grade 2.5,15 patients were WORMS grade three and 16 patients were WORMS grade four.The invalid group were 56 patients,among which 31 patients were K-L gradeⅡ,28 patients with K-L gradeⅢ,10 patients were WORMS grade four,29 patients were WORMS grade five,and 20 patients were WORMS grade six.The postoperative KOOS scores were higher than those before sur

关 键 词：软骨 老年人 骨关节炎 膝 关节镜 治疗效果 

分 类 号：R68[医药卫生—骨科学]