Felson David T, McLaughlin Sara, Goggins Joyce, LaValley Michael P, Gale M Elon, Totterman Saara, Li Wei, Hill Catherine, Gale Daniel
Boston University School of Medicine, Boston, Massachusetts 02118, USA.
Ann Intern Med. 2003 Sep 2;139(5 Pt 1):330-6. doi: 10.7326/0003-4819-139-5_part_1-200309020-00008.
While factors affecting the course of knee osteoarthritis are mostly unknown, lesions on bone scan and mechanical malalignment increase risk for radiographic deterioration. Bone marrow edema lesions on magnetic resonance imaging correspond to bone scan lesions.
To determine whether edema lesions in the subarticular bone in patients with knee osteoarthritis identify knees at high risk for radiographic progression and whether these lesions are associated with limb malalignment.
Natural history study.
A Veterans Administration hospital in Boston, Massachusetts.
Persons 45 years of age and older with symptomatic knee osteoarthritis.
Baseline assessments included magnetic resonance imaging of the knee and fluoroscopically positioned radiography. During follow-up at 15 and 30 months, patients underwent repeated radiography; at 15 months, long-limb films were obtained to assess mechanical alignment. Progression was defined as an increase over follow-up in medial or lateral joint space narrowing, based on a semi-quantitative grading. Generalized estimating equations were used to evaluate the relation of medial bone marrow edema lesions to medial progression and lateral lesions to lateral progression, before and after adjustment for limb alignment.
Of 256 patients, 223 (87.1%) participated in at least one follow-up examination. Medial bone marrow lesions were seen mostly in patients with varus limbs, and lateral lesions were seen mostly in those with valgus limbs. Twenty-seven of 75 knees with medial lesions (36.0%) showed medial progression versus 12 of 148 knees without lesions (8.1%) (odds ratio for progression, 6.5 [95% CI, 3.0 to 14.0]). Approximately 69% of knees that progressed medially had medial lesions, and lateral lesions conferred a marked risk for lateral progression. These increased risks were attenuated by 37% to 53% after adjustment for limb alignment.
Bone marrow edema is a potent risk factor for structural deterioration in knee osteoarthritis, and its relation to progression is explained in part by its association with limb alignment.
虽然影响膝骨关节炎病程的因素大多不明，但骨扫描上的病变和机械性力线不正会增加影像学恶化的风险。磁共振成像上的骨髓水肿病变与骨扫描病变相对应。
确定膝骨关节炎患者关节下骨的水肿病变是否可识别出影像学进展高危的膝关节，以及这些病变是否与肢体力线不正相关。
自然史研究。
马萨诸塞州波士顿的一家退伍军人管理局医院。
45岁及以上有症状的膝骨关节炎患者。
基线评估包括膝关节磁共振成像和荧光透视定位X线摄影。在15个月和30个月的随访期间，患者接受重复X线摄影；在15个月时，获取长腿片以评估机械性力线。进展定义为随访期间内侧或外侧关节间隙变窄增加，基于半定量分级。在调整肢体力线前后，使用广义估计方程评估内侧骨髓水肿病变与内侧进展以及外侧病变与外侧进展之间的关系。
256例患者中，223例（87.1%）参与了至少一次随访检查。内侧骨髓病变多见于内翻肢体的患者，外侧病变多见于外翻肢体的患者。75例有内侧病变的膝关节中有27例（36.0%）出现内侧进展，而148例无病变的膝关节中有12例（8.1%）出现内侧进展（进展的比值比为6.5[95%CI，3.0至14.0]）。内侧进展的膝关节中约69%有内侧病变，外侧病变显著增加外侧进展的风险。在调整肢体力线后，这些增加的风险降低了37%至53%。
骨髓水肿是膝骨关节炎结构恶化的一个重要危险因素，其与进展的关系部分可由其与肢体力线的关联来解释。
