Department of Physical Medicine and Rehabilitation, İstanbul University, Istanbul, Turkey.
Rheumatol Int. 2013 Mar;33(3):711-7. doi: 10.1007/s00296-012-2441-1. Epub 2012 May 5.
We aimed to investigate (1) the probable correlation between clinical and ultrasonographic findings in chronic painful primary knee OA patients referred with acute flare-ups and (2) the impact of diagnostic ultrasonography (US) to determine the real source of pain in these patients. We included 100 patients consecutively who were admitted to our outpatient unit with a pain complaint on a single knee with the diagnosis of primary knee OA according to the ACR criteria. The control group consisted of the patients with pain-free knees at least during the last month, who were already included in the study group. The sonographic evaluation of the knee was performed by a physician who was blinded to the clinical evaluation and/or the physical and radiological evaluations. In the present study, sonographic findings were significantly more observed on the painful knees (p < 0.001). The most commonly encountered findings on the symptomatic knees were the suprapatellar effusion (55 %), the baker cyst (25 %), and the pes anserine bursitis. The distribution of the findings on the asymptomatic knees was as follows: 22 %, the suprapatellar effusion and 5 %, the Baker cyst. Effusion was detected in 55 % of the painful knees of our patients with knee OA. This finding was statistically significant compared to the painless knees of the subjects included. The results of our study also showed that there was a significant relation between the Kellgren-Lawrence grading and the frequency of suprapatellar effusion on US examination (p = 0.026). It was concluded that in chronic, primary, painful knee osteoarthritis, US is a valuable diagnostic method in the confirmation of synovitis and/or the inflammatory episode in spite of the absence of obvious clinical parameters. In advanced osteoarthritis, when we consider that the inflammatory episodes are expected findings, the early confirmation of the inflammation on US may be particularly valuable in the clinical setting.
（1）在因急性发作而就诊的慢性、持续性、原发性膝关节骨关节炎疼痛患者中，临床和超声表现之间可能存在的相关性；（2）诊断性超声（US）在确定这些患者疼痛真实来源方面的作用。我们连续纳入了 100 名单侧膝关节疼痛的患者，这些患者均根据 ACR 标准诊断为原发性膝关节骨关节炎，且在过去一个月至少有过一次膝关节无痛期。对照组由至少在过去一个月无痛的患者组成，他们已经包含在研究组中。膝关节的超声评估由一位医师进行，该医师对临床评估和/或体格检查和影像学评估结果均不知情。在本研究中，疼痛膝关节的超声发现明显更多（p<0.001）。症状性膝关节最常见的超声发现是髌上囊积液（55%）、贝克囊肿（25%）和鹅足滑囊炎。无症状膝关节的发现分布如下：22%为髌上囊积液，5%为贝克囊肿。在我们膝关节骨关节炎患者中，55%的疼痛膝关节存在积液。与纳入的无症状膝关节相比，这一发现具有统计学意义。我们的研究结果还表明，Kellgren-Lawrence 分级与 US 检查时髌上囊积液的频率之间存在显著关系（p=0.026）。总之，在慢性、原发性、持续性膝关节骨关节炎中，US 是一种有价值的诊断方法，可用于确认滑膜炎和/或炎症发作，尽管缺乏明显的临床参数。在晚期骨关节炎中，由于炎症发作是预期的发现，因此 US 早期确认炎症可能在临床环境中特别有价值。
