膝关节对线不良与负重更大区域骨骨髓病变的发生率和增大风险相关：MOST 研究。
Knee malalignment is associated with an increased risk for incident and enlarging bone marrow lesions in the more loaded compartments: the MOST study.
机构信息
Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA.
出版信息
Osteoarthritis Cartilage. 2012 Nov;20(11):1227-33. doi: 10.1016/j.joca.2012.07.020. Epub 2012 Aug 5.
OBJECTIVE
To examine the relationship of knee malalignment with occurrence of incident and enlarging bone marrow lesions (BMLs) and regression of BMLs.
METHODS
Subjects from the Multicenter Osteoarthritis Study aged 50-79 years with or at high risk of knee osteoarthritis were studied. Full-limb radiographs were taken at baseline and hip-knee-ankle mechanical axis was measured. Baseline and 30-month magnetic resonance imaging (MRI) of knees (n = 1782) were semiquantitatively assessed for BMLs. Outcome was defined as a change in BML score in femoral/tibial condyle in medial/lateral compartments. Medial compartment in varus alignment and lateral compartment in valgus alignment were combined to form 'more loaded' compartment, while lateral compartment in valgus and medial compartment in varus were combined to form 'less loaded' compartment. Relative risk (RR) of BML score increase or decrease in relation to malalignment was estimated using a log linear regression model with the Poisson assumption, adjusting for age, gender, body mass index, physical activity scale for the elderly, race and clinic site. Further, results were stratified by ipsilateral meniscal and cartilage status at baseline.
RESULTS
Baseline varus alignment was associated with higher risk of BML score increase from baseline to follow-up in the medial compartment [adjusted RRs (95%CI): 1.5 (1.2-1.9)] and valgus alignment in the lateral compartment [1.4 (1.0-2.1)]. Increase in BML score was more likely in the more loaded compartments [1.7 (1.4-2.0)] in malaligned knees. Regardless of ipsilateral cartilage or meniscus status, adjusted RR for BML score increase was higher in the more loaded compartments of malaligned knees than those with neutral alignment. Decrease in BML score was less likely in the more loaded compartments in malaligned knees [0.8 (0.7-1.0)].
CONCLUSION
Knee malalignment is associated with increased risk of incident and enlarging BMLs in the more loaded compartments of the tibiofemoral joint.
目的
探讨膝关节对线不良与骨髓病变（BML）发生和增大以及 BML 消退的关系。
方法
本研究纳入了多中心骨关节炎研究中的年龄在 50-79 岁之间的受试者，这些受试者患有或有膝关节骨关节炎的高风险。在基线时拍摄全下肢 X 线片，并测量髋膝踝机械轴。对 1782 例膝关节的基线和 30 个月的磁共振成像（MRI）进行半定量评估，以评估 BML 情况。结果定义为股骨/胫骨髁内侧/外侧间室 BML 评分的变化。在有内翻畸形的内侧间室和有外翻畸形的外侧间室被合并为“负重较多”间室，而在有外翻畸形的外侧间室和有内翻畸形的内侧间室被合并为“负重较少”间室。使用具有泊松假设的对数线性回归模型，根据对线不良情况，调整年龄、性别、体重指数、老年人体力活动量表、种族和临床中心，估计 BML 评分增加或减少的相对风险（RR）。此外，还根据基线时的同侧半月板和软骨状况对结果进行了分层。
结果
基线时的内翻对线与内侧间室 BML 评分从基线到随访的增加相关（校正后的 RR[95%CI]：1.5[1.2-1.9]），而外侧间室的外翻对线则与之相关[1.4[1.0-2.1]）。在对线不良的膝关节中，BML 评分增加更可能发生在“负重较多”的间室[1.7（1.4-2.0）]。无论同侧软骨或半月板状况如何，在对线不良的膝关节中，“负重较多”间室的 BML 评分增加的校正 RR 均高于中立对线的膝关节。在对线不良的膝关节中，BML 评分减少不太可能发生在“负重较多”的间室[0.8（0.7-1.0）]。
结论
膝关节对线不良与负重较多的胫股关节间室中 BML 的发生和增大有关。
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