中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (4): 600-605.doi: 10.12307/2022.962

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

半月板外突与髌股关节软骨损伤及骨髓病变：MRI半定量评分的评价

郭颖奇，宫先旭，张  岩，肖  寒，王  野，谷文光   

  1. 哈尔滨医科大学附属第一医院创伤骨科，黑龙江省哈尔滨市   150001
  • 收稿日期:2021-11-18 接受日期:2022-01-07 出版日期:2023-02-08 发布日期:2022-06-23
  • 通讯作者: 谷文光，博士，主任医师，哈尔滨医科大学附属第一医院创伤骨科，黑龙江省哈尔滨市 150001
  • 作者简介:郭颖奇，男，1994 年生，四川省广安市人，汉族，哈尔滨医科大学在读硕士，主要从事运动医学、关节外科、创伤骨科等相关研究。

Meniscus extrusion and patellofemoral joint cartilage injury and bone marrow lesions: MRI semi-quantitative score

Guo Yingqi, Gong Xianxu, Zhang Yan, Xiao Han, Wang Ye, Gu Wenguang   

  1. Department of Traumatic Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
  • Received:2021-11-18 Accepted:2022-01-07 Online:2023-02-08 Published:2022-06-23
  • Contact: Gu Wenguang, MD, Chief physician, Department of Traumatic Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
  • About author:Guo Yingqi, Master candidate, Department of Traumatic Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China

PDF

43

摘要：

文题释义：
半月板外突：是指半月板异常超出胫骨平台边缘(如果存在骨赘，则将其排除在测量范围之外)，其与半月板损伤、半月板退行性病变等因素相关，半月板外突可加快膝骨关节炎进展，甚至导致自发性骨坏死、骨髓病变等。有文献报道内侧半月板外突是膝骨关节炎进展的独立预测因子。
髌股关节骨关节炎：膝关节间室大致分为内、外侧胫股关节间室以及髌股关节间室。髌股关节骨关节炎作为膝骨关节炎一种重要亚型，在中老年人群中发病率较高，患者在负重屈膝、上下楼时膝前痛症状较为明显，严重影响患者日常生活质量。

背景：半月板损伤对膝骨关节影响的研究多集中在胫股关节间室，国外有半月板外突与髌股关节骨关节炎相关性报道，但国内相关研究较少。
目的：基于骨关节炎倡议数据库(OAI)的公开数据，以MRI半定量评分评价半月板外突与髌股关节骨关节炎的相关性。
方法：数据库中选取在基线时有完整MRI膝骨关节炎评分以及其他临床信息完整的参与者共1 109人作为研究对象。采用MRI膝骨关节炎评分系统对研究对象的半月板撕裂、浸渍、外突以及髌股关节软骨、骨髓病变进行评分，采用问卷等方法采集了参与者的性别、年龄、种族、体质量指数、膝关节受伤史、手术史等信息。使用Logistic 回归分析确定半月板外突与髌股关节骨关节炎的关系。
结果与结论：①横断面研究显示，内、外侧半月板外突人群在内、外侧髌股关节中易发生软骨及全层软骨损伤和骨髓病变；②Logistics回归分析在调整混杂因素后(调整模型2)，内侧半月板外突与内侧髌股关节任何软骨损伤[OR：2.4(95%CI：1.6，3.6)]、全层软骨损伤[OR：1.5(95%CI：1.0，2.1)]呈正相关，在未调整[OR：0.8(95%CI：0.6，1.1)]与调整混杂因素后[OR：1.3(95%CI：0.9，1.8)]内侧半月板外突与内侧髌股关节骨髓病变均无相关性；③在调整混杂因素后(调整模型2)，外侧半月板外突与外侧髌股关节任何软骨损伤[OR：2.1(95%CI：1.0，4.5)]、全层软骨损伤[OR：2.3(95%CI：1.1，4.6)]呈正相关，在未调整混杂因素时[OR：1.7(95%CI：1.0，2.9)]，外侧半月板外突与外侧髌股关节骨髓病变呈正相关，在调整混杂因素后[OR：1.1(95%CI：0.6，2.1)]两者无相关；④基于骨关节炎倡议数据库(OAI)的公开数据，分析结果显示美国人群中半月板外突与髌股关节软骨损伤呈正相关。
缩略语：MRI膝骨关节炎评分：MRI osteoarthritis knee score，MOAKS

https://orcid.org/0000-0001-5852-6732 (郭颖奇)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 半月板外突, 半月板损伤, 髌股关节骨关节炎, 膝关节骨关节炎, 核磁共振, 横断面研究, 软骨损伤

Abstract: BACKGROUND: The research on the effect of meniscus injury on knee osteoarthritis is mostly concentrated in the tibiofemoral compartment. There are reports on the correlation between meniscus extrusion and patellofemoral osteoarthritis outside China, but there are few related studies in China.
OBJECTIVE: To explore the association between meniscus extrusion and patellofemoral osteoarthritis based on published data from the Osteoarthritis Initiative.
METHODS: Totally 1 109 participants with complete MRI Osteoarthritis Knee Score and other clinical information at baseline were selected. Meniscal tear, maceration, extrusion, patellofemoral cartilage and bone marrow lesions were scored by MRI Osteoarthritis Knee Score semi-quantitative scoring system. Gender, age, race, body mass index, history of knee injury, and history of surgery were collected by questionnaire. Logistic regression analysis was used to determine the relationship between meniscal extrusion and patellofemoral osteoarthritis. 
RESULTS AND CONCLUSION: (1) The cross-sectional study showed that patients with medial and lateral meniscus extrusion had a high incidence of any cartilage injury, full-thickness cartilage injury, and bone marrow lesions in medial and lateral patellofemoral joint. (2) Logistic regression analysis showed that after adjusting for confounding factors (adjustment model 2), the medial meniscus extrusion was positively correlated with any cartilage injury of the medial patellofemoral joint [OR: 2.4(95% CI: 1.6, 3.6)] and full-thickness cartilage injury [OR: 1.5(95% CI: 1.0, 2.1)]; there was no correlation between medial meniscus extrusion and medial patellofemoral joint bone marrow lesions without adjustment [OR: 0.8(95% CI: 0.6, 1.1)] and after adjustment for confounding factors [OR: 1.3(95% CI: 0.9, 1.8)]. (3) After adjusting for confounding factors (adjustment model 2), lateral meniscus extrusion was positively correlated with any cartilage injury of the lateral patellofemoral joint [OR: 2.1(95% CI: 1.0, 4.5)] and full-thickness cartilage injury [OR: 2.3(95% CI:1.1, 4.6)]; while without adjusting for confounding factors [OR: 1.7(95% CI: 1.0, 2.9)], lateral meniscus extrusion was positively correlated with bone marrow lesions of the lateral patellofemoral joint, but not after adjustment for confounding factors [OR: 1.1(95% CI: 0.6, 2.1)]. (4) Meniscus extrusion was positively correlated with cartilage injury of patellofemoral joint among Americans based on published data from the Osteoarthritis Initiative.

Key words: meniscal extrusion, meniscus injury, patellofemoral osteoarthritis, knee osteoarthritis, magnetic resonance imaging, cross-sectional study, cartilage injury

中图分类号: