超声联合红外热成像对膝骨性关节炎的评估
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摘要
目的了解超声联合红外热成像评估膝关节骨性关节炎疼痛及功能障碍的价值。方法膝关节骨性关节炎病人42例,采用彩色超声诊断仪检测病人软骨磨损程度,按照超声检查结果将研究对象分为轻度组(23例)和中重度组(19例)。使用视觉模拟评分(VAS)、WOMAC骨关节炎指数对受试者的疼痛和功能障碍进行评估。于就诊当天及4周后使用SP-9000医用红外热成像仪进行红外热成像检查。结果超声检测显示的膝关节软骨磨损程度与膝关节骨性关节炎的疼痛呈强相关(r=0.817,P<0.01),与WOMAC骨关节炎指数呈强相关(r=0.827,P<0.01)。膝关节髌骨温度与超声检测的软骨磨损程度呈中度相关(r=0.442,P<0.01),上内侧温度、下内侧温度与软骨磨损程度均呈弱相关(r=0.350、0.386,P<0.01);上内侧温度与疼痛及WOMAC骨关节炎指数呈中度相关(r=0.490、0.438,P<0.01);膝关节髌骨温度与疼痛、WOMAC骨关节炎指数呈中度相关(r=0.431、0.397,P<0.01);膝关节下内侧温度与疼痛、WOMAC骨关节炎指数呈弱相关(r=0.373、0.311,P<0.05)。受试当天及4周后两次膝关节红外热成像检查提示红外热成像评估膝关节的可信度和可重复性均良好(ICC范围为0.73～0.84)。结论红外热成像和超声检查在膝关节骨性关节炎评估过程中联合应用,可以一定程度上评定膝关节骨性关节炎的疼痛和功能障碍。
Objective To investigate the value of musculoskeletal ultrasound combined with infrared thermal imaging in evaluating pain and dysfunction in patients with knee osteoarthritis. Methods A total of 42 patients with knee osteoarthritis were enrolled in this study.Color Doppler echocardiography was used to evaluate the degree of cartilage wear,and according to the ultrasound findings,the patients were divided into mild group with 23 patients and moderate-to-severe group with 19 patients.Visual Analogue Scale(VAS)and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)were used to evaluate pain and dysfunction in these patients.The SP-9000 medical infrared thermal imager was used for infrared thermal imaging on the day of the test and at 4 weeks after the test. Results Ultrasound showed that the degree of knee cartilage wear was strongly correlated with the pain of knee osteoarthritis(r=0.817,P<0.01)and WOMAC(r=0.827,P<0.01).There was a moderate correlation between patellar temperature and degree of cartilage wear on ultrasound(r=0.442,P<0.01),and the upper medial temperature and the lower medial temperature were weakly correlated with the degree of cartilage wear on ultrasound(r=0.350 and0.386,P<0.01).The upper medial temperature was moderately correlated with pain(r=0.490,P<0.01)and WOMAC(r=0.438,P<0.01).Patellar temperature was moderately correlated with pain and WOMAC(r=0.431 and 0.397,P<0.01),and the lower medial temperature was weakly correlated with pain and WOMAC(r=0.373 and 0.311,P<0.05).Infrared thermal imaging on the day of the test and at 4 weeks after the test confirmed the reliability and repeatability of infrared thermal imaging in evaluating the knee joint(ICC=0.73-0.84). Conclusion Infrared thermal imaging combined with ultrasound can be used to assess the pain and dysfunction of knee osteoarthritis.
Objective To investigate the value of musculoskeletal ultrasound combined with infrared thermal imaging in evaluating pain and dysfunction in patients with knee osteoarthritis. Methods A total of 42 patients with knee osteoarthritis were enrolled in this study.Color Doppler echocardiography was used to evaluate the degree of cartilage wear,and according to the ultrasound findings,the patients were divided into mild group with 23 patients and moderate-to-severe group with 19 patients.Visual Analogue Scale(VAS)and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)were used to evaluate pain and dysfunction in these patients.The SP-9000 medical infrared thermal imager was used for infrared thermal imaging on the day of the test and at 4 weeks after the test. Results Ultrasound showed that the degree of knee cartilage wear was strongly correlated with the pain of knee osteoarthritis(r=0.817,P<0.01)and WOMAC(r=0.827,P<0.01).There was a moderate correlation between patellar temperature and degree of cartilage wear on ultrasound(r=0.442,P<0.01),and the upper medial temperature and the lower medial temperature were weakly correlated with the degree of cartilage wear on ultrasound(r=0.350 and0.386,P<0.01).The upper medial temperature was moderately correlated with pain(r=0.490,P<0.01)and WOMAC(r=0.438,P<0.01).Patellar temperature was moderately correlated with pain and WOMAC(r=0.431 and 0.397,P<0.01),and the lower medial temperature was weakly correlated with pain and WOMAC(r=0.373 and 0.311,P<0.05).Infrared thermal imaging on the day of the test and at 4 weeks after the test confirmed the reliability and repeatability of infrared thermal imaging in evaluating the knee joint(ICC=0.73-0.84). Conclusion Infrared thermal imaging combined with ultrasound can be used to assess the pain and dysfunction of knee osteoarthritis.
引文
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[24]IGNACIO M C,JOSE M R,MELLADO-LOPEZ MARA-VILLAS,et al.Human suprapatellar fat pad-derived mesenchymal stem cells induce chondrogenesis and cartilage repair in a model of severe osteoarthritis[J].Stem Cells International,2017,2017:1-12.
[25]ZHANG M J,MANI S B,HE Y,et al.Induced superficial chondrocyte death reduces catabolic cartilage damage in murine posttraumatic osteoarthritis[J].Journal of Clinical Investigation,2016,126(8):2893-2902.
[26]MA C H,WU C H,JOU I M,et al.PKR activation causes inflammation and MMP-13secretion in human degenerated articular chondrocytes[J].Redox Biology,2018,14:72-81.
[27]HAZENBERG C B,VAN NETTEN J J,VAN BAAL S G,et al.Assessment of signs of foot infection in diabetes patients using photographic foot imaging and infrared thermography[J].Diabetes Technology&Therapeutics,2014,16(6):370-377.
[28]姚益冰,谢可越,黄冰,等.红外线热成像用于带状疱疹的早期诊断价值[J].中华全科医学,2018,16(1):7-9,29.
[2]HART H F,STEFANIK J J,WYNDOW N,et al.The prevalence of radiographic and MRI-defined patellofemoral osteoarthritis and structural pathology:a systematic review and meta-analysis[J].British Journal of Sports Medicine,2017,51(16):1195-1208.
[3]PODLIPSKA J,KOSKI J M,KAUKINEN P,et al.Structure-symptom relationship with wide-area ultrasound scanning of knee osteoarthritis[J].Scientific Reports,2017,7:1-10.
[4]CALDERS P,VAN GINCKEL A.Presence of comorbidities and prognosis of clinical symptoms in knee and/or hip osteoarthritis:a systematic review and meta-analysis[J].Seminars in Arthritis and Rheumatism,2017,47(6):805-813.
[5]MALAS F U,KARA M,KAYMAK B,et al.Ultrasonographic evaluation in symptomatic knee osteoarthritis:clinical and radiological correlation[J].International Journal of Rheumatic Diseases,2014,17(5):536-540.
[6]CHEN Y J,CHEN C H,WANG C L,et al.Association between the severity of femoral condylar cartilage erosion related to knee osteoarthritis by ultrasonographic evaluation and the clinical symptoms and functions[J].Archives of Physical Medicine and Rehabilitation,2015,96(5):837-844.
[7]RAZEK A A,EL B R.Ultrasound of knee osteoarthritis:interobserver agreement and correlation with Western Ontario and McMaster Universities Osteoarthritis[J].Clinical Rheumatology,2016,35(4):997-1001.
[8]SHEEHY L,CULHAM E,MCLEAN L,et al.Validity and sensitivity to change of three scales for the radiographic assessment of knee osteoarthritis using images from the Multicenter Osteoarthritis Study(MOST)[J].Osteoarthritis and Cartilage,2015,23(9):1491-1498.
[9]BOESEN M,ELLEGAARD K,HENRIKSEN M,et al.Osteoarthritis year in review 2016:imaging[J].Osteoarthritis and Cartilage,2017,25(2):216-226.
[10]USAMENTIAGA R,MOKHTARI Y,IBARRA C C,et al.Automated dynamic inspection using active infrared thermography[J].IEEE Transactions on Industrial Informatics,2018(99):1.doi:10.1109/TII.2018.2836363.
[11]YANG R Z,HE Y Z,MANDELIS A,et al.Induction infrared thermography and the imaging Wave-Radar analysis for imaging inspection and diagnosis of blade composites[J].IEEETransactions on Industrial Informatics,2018,14(12):5637-5647.
[12]OMAR T,NEHDI M L,ZAYED T.Infrared thermography model for automated detection of delamination in RC bridge decks[J].Construction&Building Materials,2018,168:313-327.
[13]DENOBLE A E,HALL N,PIEPER C F,et al.Patellar skin surface temperature by thermography reflects knee osteoarthritis severity[J].Clinical Medicine Insights Arthritis&Musculoskeletal Disorders,2010,3(3):69-75.
[14]ARFAOUI A,BOUZID M A,PRON H,et al.Application of infrared thermography as a diagnostic Tool of knee osteoarthritis[J].Journal of Thermal Science and Technology,2012,7(1):227-235.
[15]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.
[16]SAARAKKALA S,WARIS P,WARIS V,et al.Diagnostic performance of knee ultrasonography for detecting degenerative changes of articular cartilage[J].Osteoarthritis and Cartilage,2012,20(5):376-381.
[17]严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,8(2):273.
[18]BELLAMY N.Pain assessment in osteoarthritis:experience with the WOMAC osteoarthritis index[J].Seminars in Arthritis and Rheumatism,1989,18(4Suppl 2):14-17.
[19]CHANG T C,HSIAO Y L,LIAO S L.Application of digital infrared thermal imaging in determining inflammatory state and follow-up effect of methylprednisolone pulse therapy in patients with Graves’ophthalmopathy[J].Graefes Archive for Clinical and Experimental Ophthalmology,2008,246(1):45-49.
[20]KALICHMAN L,ZHU Y,ZHANG Y,et al.The association between patella alignment and knee pain and function:an MRIstudy in persons with symptomatic knee osteoarthritis[J].Osteoarthritis and Cartilage,2007,15(11):1235-1240.
[21]LIU A,KENDZERSKA T,STANAITIS I,et al.The relationship between knee pain characteristics and symptom state acceptability in People with knee osteoarthritis[J].Osteoarthritis and Cartilage,2014,22(2):178-183.
[22]JAMTVEDT G,DAHM K T,HOLM I,et al.Choice of treatment modalities was not influenced by pain,severity or comorbidity in patients with knee osteoarthritis[J].Physiotherapy Research International,2010,15(1):16-23.
[23]SINGER B J,SILBERT B I,SILBERT P L.The role of botulinum toxin type a in the clinical management of refractory anterior knee pain[J].Toxins,2015,7(9):3388-3404.
[24]IGNACIO M C,JOSE M R,MELLADO-LOPEZ MARA-VILLAS,et al.Human suprapatellar fat pad-derived mesenchymal stem cells induce chondrogenesis and cartilage repair in a model of severe osteoarthritis[J].Stem Cells International,2017,2017:1-12.
[25]ZHANG M J,MANI S B,HE Y,et al.Induced superficial chondrocyte death reduces catabolic cartilage damage in murine posttraumatic osteoarthritis[J].Journal of Clinical Investigation,2016,126(8):2893-2902.
[26]MA C H,WU C H,JOU I M,et al.PKR activation causes inflammation and MMP-13secretion in human degenerated articular chondrocytes[J].Redox Biology,2018,14:72-81.
[27]HAZENBERG C B,VAN NETTEN J J,VAN BAAL S G,et al.Assessment of signs of foot infection in diabetes patients using photographic foot imaging and infrared thermography[J].Diabetes Technology&Therapeutics,2014,16(6):370-377.
[28]姚益冰,谢可越,黄冰,等.红外线热成像用于带状疱疹的早期诊断价值[J].中华全科医学,2018,16(1):7-9,29.