Felson D T, Chaisson C E, Hill C L, Totterman S M, Gale M E, Skinner K M, Kazis L, Gale D R
Boston University School of Medicine, 715 Albany Street, A203, Boston, MA 02118, USA.
Ann Intern Med. 2001 Apr 3;134(7):541-9. doi: 10.7326/0003-4819-134-7-200104030-00007.
The cause of pain in osteoarthritis is unknown. Bone has pain fibers, and marrow lesions, which are thought to represent edema, have been noted in osteoarthritis.
To determine whether bone marrow lesions on magnetic resonance imaging (MRI) are associated with pain in knee osteoarthritis.
Cross-sectional observational study.
Veterans Affairs Medical Center.
401 persons (mean age, 66.8 years) with knee osteoarthritis on radiography who were drawn from clinics in the Veterans Administration health care system and from the community. Of these persons, 351 had knee pain and 50 had no knee pain.
Knee radiography and MRI of one knee were performed in all participants. Those with knee pain quantified the severity of their pain. On MRI, coronal T(2)-weighted fat-saturated images were used to score the size of bone marrow lesions, and each knee was characterized as having any lesion or any large lesion. The prevalence of lesions and large lesions in persons with and without knee pain was compared; in participants with knee pain, the presence of lesions was correlated with severity of pain.
Bone marrow lesions were found in 272 of 351 (77.5%) persons with painful knees compared with 15 of 50 (30%) persons with no knee pain (P < 0.001). Large lesions were present almost exclusively in persons with knee pain (35.9% vs. 2%; P < 0.001). After adjustment for severity of radiographic disease, effusion, age, and sex, lesions and large lesions remained associated with the occurrence of knee pain. Among persons with knee pain, bone marrow lesions were not associated with pain severity.
Bone marrow lesions on MRI are strongly associated with the presence of pain in knee osteoarthritis.
骨关节炎疼痛的病因尚不清楚。骨骼有痛觉纤维，且在骨关节炎中已发现骨髓损伤，一般认为这代表水肿。
确定磁共振成像（MRI）显示的骨髓损伤是否与膝关节骨关节炎疼痛相关。
横断面观察性研究。
退伍军人事务医疗中心。
从退伍军人管理局医疗保健系统的诊所和社区招募的401例经X线摄影诊断为膝关节骨关节炎的患者（平均年龄66.8岁）。其中，351例有膝关节疼痛，50例无膝关节疼痛。
所有参与者均进行了一侧膝关节的X线摄影和MRI检查。有膝关节疼痛的患者对其疼痛严重程度进行量化。在MRI上，采用冠状位T2加权脂肪抑制图像对骨髓损伤的大小进行评分，每个膝关节被分为有任何损伤或有任何大的损伤。比较有和没有膝关节疼痛的患者中损伤和大损伤的患病率；在有膝关节疼痛的参与者中，损伤的存在与疼痛严重程度相关。
351例膝关节疼痛患者中有272例（77.5%）发现骨髓损伤，而50例无膝关节疼痛患者中有15例（30%）发现骨髓损伤（P<0.001）。大的损伤几乎仅见于膝关节疼痛患者（35.9%对2%；P<0.001）。在调整了放射学疾病严重程度、积液、年龄和性别后，损伤和大的损伤仍与膝关节疼痛的发生相关。在有膝关节疼痛的患者中，骨髓损伤与疼痛严重程度无关。
MRI显示的骨髓损伤与膝关节骨关节炎疼痛的存在密切相关。
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