Sanghi Divya, Avasthi Sachin, Mishra Abhishek, Singh Ajai, Agarwal Sarita, Srivastava Rajeshwar Nath
Department of Orthopaedic Surgery, Erstwhile KG Medical College, CSM Medical University, Lucknow, 226003, UP, India.
J Orthop Sci. 2011 Nov;16(6):719-25. doi: 10.1007/s00776-011-0147-y. Epub 2011 Aug 27.
Discordance between clinical and radiological profiles in knee osteoarthritis has been reported. We hypothesized that the discordance could be due to limited radiological variables studied. This study essentially analyzed many more radiological features than previous studies in order to seek an association between clinical and radiographic features.
One hundred and eighty patients with knee osteoarthritis were enrolled as per the American College of Rheumatology (ACR) guidelines. Visual analog scale (VAS) for knee pain and the knee-specific Western Ontario Mac University (WOMAC) index for pain, stiffness, and disability were recorded. Five additional radiological features apart from those in the Kellgren-Lawrence (KL) classification grading system were recorded by two authors who were blinded to the clinical diagnosis. The variables significantly associated were analyzed by linear regression model.
Pain was significantly associated with increasing KL grades; physical function was nearly significant and stiffness was not. On analysis of individual radiological features, WOMAC pain was significant with subchondral sclerosis, joint space width, and tibiofemoral alignment although the correlation was week. VAS pain was significant with the latter two and with articular incongruity. Functional disability was associated with medial joint-space narrowing, tibiofemoral alignment, loose bodies, and juxta-articular osteopenia. However, in the linear regression model, pain and stiffness were significantly associated with articular incongruity and functional disability and total clinical scores with juxta-articular osteopenia.
When the radiological features were extended beyond those included in KL grades, pain, stiffness, and disability correlated well with radiography; articular incongruity with pain and stiffness; and juxta-articular osteopenia with physical disability and clinical severity.
已有报道称膝关节骨关节炎的临床特征与放射学特征之间存在不一致。我们推测这种不一致可能是由于所研究的放射学变量有限。本研究本质上分析了比以往研究更多的放射学特征，以探寻临床特征与放射学特征之间的关联。
按照美国风湿病学会（ACR）指南纳入180例膝关节骨关节炎患者。记录膝关节疼痛的视觉模拟量表（VAS）以及针对疼痛、僵硬和功能障碍的膝关节特异性西安大略和麦克马斯特大学（WOMAC）指数。除了Kellgren-Lawrence（KL）分类分级系统中的特征外，另外五个放射学特征由两位对临床诊断不知情的作者进行记录。通过线性回归模型分析显著相关的变量。
疼痛与KL分级增加显著相关；身体功能接近显著相关，而僵硬则不相关。对个体放射学特征进行分析时，WOMAC疼痛与软骨下硬化、关节间隙宽度和胫股对线显著相关，尽管相关性较弱。VAS疼痛与后两者以及关节不协调显著相关。功能障碍与内侧关节间隙变窄、胫股对线、游离体和关节周围骨质减少相关。然而，在线性回归模型中，疼痛和僵硬与关节不协调以及功能障碍显著相关，而总临床评分与关节周围骨质减少显著相关。
当放射学特征扩展到KL分级所包含的特征之外时，疼痛、僵硬和功能障碍与放射学表现有良好的相关性；关节不协调与疼痛和僵硬相关；关节周围骨质减少与身体功能障碍和临床严重程度相关。
