贵阳市症状性膝骨关节炎疼痛与关节间隙狭窄影像学表现的相关性研究
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摘要
目的探讨贵阳市症状性膝骨关节炎患者疼痛与关节间隙狭窄影像学表现的相关性。方法收集贵阳市七家大型医院自2014年1月至2015年12月就诊的症状性膝骨关节炎(knee osteoarthritis,KOA)患者。纳入标准为符合美国风湿病学会修订的KOA诊断标准,且X线片示Kellgren&Lawrence分级Ⅱ级及以上者。共993例患者纳入研究,其中男304例,女689例,采用流行病学问卷调查,并行X线片膝关节正侧位投照,记录患者疼痛部位、疼痛程度,分析骨赘生成部位、骨关节间隙变窄情况。数据采用SPSS 19.0软件进行统计学分析。结果 993例KOA患者,膝关节压痛出现在髌骨周围631例、内侧关节间隙469例、外侧关节间隙132例,109例患者无明显压痛部位,286例患者存在多部位压痛。轻度疼痛290例,中度疼痛427例,重度疼痛276例。Kellgren&Lawrence分级发现Ⅱ级334例,Ⅲ级407例,Ⅳ级252例。骨赘生长部位于髁间嵴531例,胫骨关节面边缘463例,髌骨周围412例,股骨关节面56例,多部位骨赘生长672例。疼痛程度与关节间隙狭窄关系经统计学分析发现(χ~2=7.381,P>0.05)差异无统计学意义。结论症状性膝骨关节炎疼痛与关节间隙狭窄无明显相关性。
Objective To study the correlation between symptomatic knee osteoarthritis pain and joint space narrowing of patients in Guiyang City.Methods Patients with symptomatic knee osteoarthritis(KOA)who accepted treatment in seven large hospitals in Guiyang City from January 2014 to December 2015 were collected.The inclusion criteria were that the diagnostic criteria of KOA revised by American College of Rheumatology were met and Kellgren & Lawrence Grade wasⅡ and above as showed by X-ray films.A total of 993 patients were included in the study,including 304 males and 689 females.Epidemiological questionnaire survey was adopted and X-ray films of knee joint PA & LAT were taken to record the pain sites and degrees of the patients and analyze the sites of hyperostosis and the conditions of joint space narrowing.Statistical analysis was conducted on the data by SPSS19.0.Results Among 993 patients with KOA,there were 631 patients with knee joint tenderness around patella,469 patients with tenderness in medial joint space,132 patients with tenderness in lateral joint space,109 patients without obvious tenderness site and 286 patients with multiple tenderness sites.There were 290 patients with mild pain,427 patients with moderate pain and 276 patients with severe pain.According to Kellgren & Lawrence grading we found 334 patients of gradeⅡ,407 patients of grade III and 252 patients of gradeⅣ.There were 531 patients with hyperostosis growing in intercondylar eminence,463 patients with hyperostosis growing at the edge of tibial articular surface,412 patients with hyperostosis growing around patella,56 patients with hyperostosis growing on the femoral articular surface and 672 patients with hyperostosis growing at many sites.Statistical analysis on the correlation between pain degree and joint space narrowing revealed no statistically significant difference(χ~2=7.381,P >0 0.05).Conclusion There is no significant correlation between symptomatic knee osteoarthritis pain and joint space narrowing.
Objective To study the correlation between symptomatic knee osteoarthritis pain and joint space narrowing of patients in Guiyang City.Methods Patients with symptomatic knee osteoarthritis(KOA)who accepted treatment in seven large hospitals in Guiyang City from January 2014 to December 2015 were collected.The inclusion criteria were that the diagnostic criteria of KOA revised by American College of Rheumatology were met and Kellgren & Lawrence Grade wasⅡ and above as showed by X-ray films.A total of 993 patients were included in the study,including 304 males and 689 females.Epidemiological questionnaire survey was adopted and X-ray films of knee joint PA & LAT were taken to record the pain sites and degrees of the patients and analyze the sites of hyperostosis and the conditions of joint space narrowing.Statistical analysis was conducted on the data by SPSS19.0.Results Among 993 patients with KOA,there were 631 patients with knee joint tenderness around patella,469 patients with tenderness in medial joint space,132 patients with tenderness in lateral joint space,109 patients without obvious tenderness site and 286 patients with multiple tenderness sites.There were 290 patients with mild pain,427 patients with moderate pain and 276 patients with severe pain.According to Kellgren & Lawrence grading we found 334 patients of gradeⅡ,407 patients of grade III and 252 patients of gradeⅣ.There were 531 patients with hyperostosis growing in intercondylar eminence,463 patients with hyperostosis growing at the edge of tibial articular surface,412 patients with hyperostosis growing around patella,56 patients with hyperostosis growing on the femoral articular surface and 672 patients with hyperostosis growing at many sites.Statistical analysis on the correlation between pain degree and joint space narrowing revealed no statistically significant difference(χ~2=7.381,P >0 0.05).Conclusion There is no significant correlation between symptomatic knee osteoarthritis pain and joint space narrowing.
引文
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[13]林汉文,温俊茂,黄超原,等.骨关节炎患者下肢力线改变与疼痛部位的关系:影像学评价[J].中国组织工程研究,2017,21(7):1110-1114.
[14]黄淑婷,徐建华,丁长海,等.膝骨关节炎患者关节结构改变与关节疼痛症状的相关性研究[J].中华临床医师杂志,2014,8(4):628-632.
[15]Zhai G,Blizzard L,Srikanth V,et al.Correlates of knee pain in older adults:Tasmanian older adult cohort study[J].Arthritis Rheum,2006,55(2):264-271.
[16]Sharma AR,Jagga S,Lee SS,et al.Interplay between cartilage and subchondral bone contributing to pathogenesis of osteoarthritis[J].Int J Mol Sci,2013,14(10):19805-19830.
[17]Serban O,Porojan M,Deac M,et al.Pain in bilateral knee osteoarthritis correlations between clinical examination,radiological,and ultrasonographical findings[J].Medical Ultrasonography,2016,18(3):318-325.
[2]Vos T,Flaxman A,Naghavi M,et al.Years lived with disability(YLDs)for 1160sequelae of 289diseases and injuries 1990e2010:a systematic analysis for the global burden of disease study 2010[J].Lancet,2013(380):2163-2196.
[3]中华医学会风湿病学分会.骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(6):416-419.
[4]Mapp PI,Walsh DA,Bowyer J,et al.Effects of a metalloproteinase inhibitor on osteochondral angiogenesis,chondropathy and pain behavior in a rat model of osteoarthritis[J].Osteoarthritis and Cartilage,2010,18(4):593-600.
[5]Wu PT,Shao CJ,Wu KC,et al.Pain in patients with equal radiographic grades of osteoarthritis in both knees:the value of gray scale ultrasound[J].Osteoarthritis Cartilage,2012,20(12):1507-1513.
[6]Baker K,Grainger A,Niu J,et al.Relation of synovitis to knee pain using contrastenhanced MRIs[J].Ann Rheum Dis,2010,69(10):1779-1783.
[7]Neogi T,Guermazi A,Roemer F,et al.Association of joint inflammation with pain sensitization in knee osteoarthritis:the multicenter osteoarthritis study[J].Amlritis Rheumatol,2016,68(3):654-661.
[8]陆川,刘海霞,张国秋,等.膝骨关节炎疼痛与骨髓水肿MRI影像学改变的相关性[J].中国中西医结合外科杂志,2015,21(3):242-245.
[9]李广恒,戴克戎.膝关节骨关节炎分子发病机制和治疗展望[J].郑州大学学报,2015,50(2):149-152.
[10]Iorio R,Healy W L.Unicompartmental srthritis of the knee[J].J Bone Joint Surg(Am),2003,85(7):1351-1364.
[11]张旻,江澜.内侧间室膝骨关节的下肢关节生物力学变化[J].中国康复,2011,26(1):36-39.
[12]褚立希,王锋.膝骨关节炎X片生物力学及形态学测量分析[J].中西医结合学报,2004,2(6):432.
[13]林汉文,温俊茂,黄超原,等.骨关节炎患者下肢力线改变与疼痛部位的关系:影像学评价[J].中国组织工程研究,2017,21(7):1110-1114.
[14]黄淑婷,徐建华,丁长海,等.膝骨关节炎患者关节结构改变与关节疼痛症状的相关性研究[J].中华临床医师杂志,2014,8(4):628-632.
[15]Zhai G,Blizzard L,Srikanth V,et al.Correlates of knee pain in older adults:Tasmanian older adult cohort study[J].Arthritis Rheum,2006,55(2):264-271.
[16]Sharma AR,Jagga S,Lee SS,et al.Interplay between cartilage and subchondral bone contributing to pathogenesis of osteoarthritis[J].Int J Mol Sci,2013,14(10):19805-19830.
[17]Serban O,Porojan M,Deac M,et al.Pain in bilateral knee osteoarthritis correlations between clinical examination,radiological,and ultrasonographical findings[J].Medical Ultrasonography,2016,18(3):318-325.