Anandacoomarasamy Ananthila, Smith Garett, Leibman Steven, Caterson Ian, Giuffre Bruno, Fransen Marlene, Sambrook Philip, March Lyn
Department of Rheumatology, Institute of Bone and Joint Research, Kolling Institute, Sydney, NSW 2065, Australia.
Rheumatology (Oxford). 2009 Oct;48(10):1290-3. doi: 10.1093/rheumatology/kep246. Epub 2009 Aug 18.
To describe the associations between physical disability measures and knee cartilage defects in obese adults.
One hundred and eleven obese subjects were recruited from laparoscopic adjustable gastric banding or exercise/diet weight loss programmes. All subjects completed disease-specific (WOMAC) and general health status (SF-36) questionnaires, and were assessed for range of knee motion, tibiofemoral alignment and quadriceps strength. Knee cartilage defects were graded on MRI according to established protocol. Regression analysis was adjusted for age, gender, BMI and presence of clinical knee OA.
The association between higher whole compartment cartilage defect scores and increasing BMI, age and clinical knee OA was confirmed in this obese cohort (r = 0.27, P = 0.01; r = 0.26, P = 0.007; P < 0.0001, respectively), whereas new associations were found with reduced knee range of motion (r = 0.5, P < 0.0001). No associations were found between defect scores and quadriceps strength. Varus malalignment was associated with higher medial cartilage defect scores (r = 0.33, P = 0.013). Higher levels of pain, stiffness and physical disability (WOMAC, SF-36) were associated with higher medial compartment and patella cartilage defect scores.
Knee cartilage defects increase with increasing obesity and are associated with both objective and self-reported measures of physical disability. Longitudinal studies are required to assess the potential for change or improvement in cartilage defects with weight loss.
描述肥胖成年人身体残疾指标与膝关节软骨缺损之间的关联。
从腹腔镜可调节胃束带手术或运动/饮食减肥项目中招募了111名肥胖受试者。所有受试者均完成了疾病特异性（WOMAC）和一般健康状况（SF-36）问卷，并接受了膝关节活动范围、胫股对线和股四头肌力量评估。根据既定方案在MRI上对膝关节软骨缺损进行分级。回归分析针对年龄、性别、BMI和临床膝关节骨关节炎的存在情况进行了校正。
在这个肥胖队列中，全关节软骨缺损评分升高与BMI增加、年龄增长和临床膝关节骨关节炎之间的关联得到证实（r = 0.27，P = 0.01；r = 0.26，P = 0.007；P分别<0.0001），而发现与膝关节活动范围减小存在新的关联（r = 0.5，P < 0.0001）。未发现缺损评分与股四头肌力量之间存在关联。内翻畸形与较高的内侧软骨缺损评分相关（r = 0.33，P = 0.013）。较高水平的疼痛、僵硬和身体残疾（WOMAC、SF-36）与较高的内侧关节和髌骨软骨缺损评分相关。
膝关节软骨缺损随肥胖程度增加而增加，并且与身体残疾的客观指标和自我报告指标均相关。需要进行纵向研究以评估减肥后软骨缺损变化或改善的可能性。
