Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
Orthopaedic Surgery, Yamanashi Prefectural Central Hospital, Yamanashi, Japan.
J Bone Miner Metab. 2019 May;37(3):529-536. doi: 10.1007/s00774-018-0950-z. Epub 2018 Sep 5.
Osteoarthritis of the knee (knee OA) induces pain, loss of mobility and diminished activities of daily living (ADL). Although an understanding of the pathophysiology of early stage knee OA has been developed, the structural changes associated with disability for ADL in early stage knee OA are still unclear. The aim of the present study was to examine magnetic resonance imaging (MRI)-detected changes associated with disability for ADL in patients with early stage knee OA. One hundred and thirty-two patients with early stage medial knee OA (Kellgren-Lawrence grade ≤ 2) who first visited the outpatient clinic at our university hospital were included. They were also examined by 3.0-Tesla knee MRI. The OA-associated structural changes were scored using the Whole-Organ Magnetic Resonance Imaging Score (WORMS), and clinical manifestations were evaluated by the Japanese Knee Osteoarthritis Measure (JKOM). Median quartile regression was used for the analysis. Cartilage lesion, subchondral bone attrition and osteophytes were observed in all patients. Bone marrow lesions (BMLs) and synovitis were observed in 60% and 55% of the patients, respectively. Subchondral cysts and ligament changes were observed in 6% and 17% of the patients, respectively. Pain severity of the patients was associated with medial cartilage lesions (coefficient 2.50, 95% confidence interval 0.61-4.40, p < 0.01). Disability for ADL of the patients was associated with BMLs in the medial side of the knee joint (0.82, 0.21-1.02, p = 0.04). BMLs in the medial side of the knee joint were associated with disability for ADL of patients with early stage medial knee OA.
膝关节骨关节炎（膝骨关节炎）引起疼痛、活动能力丧失和日常生活活动能力（ADL）下降。尽管已经对早期膝骨关节炎的病理生理学有了一定的了解，但与早期膝骨关节炎 ADL 功能障碍相关的结构变化仍不清楚。本研究旨在探讨与早期膝骨关节炎患者 ADL 功能障碍相关的磁共振成像（MRI）检测到的变化。本研究纳入了 132 例初次就诊于我院门诊的早期内侧膝骨关节炎（Kellgren-Lawrence 分级≤2 级）患者。他们还接受了 3.0T 膝关节 MRI 检查。采用全器官磁共振成像评分（WORMS）对 OA 相关结构变化进行评分，采用日本膝关节骨关节炎评分（JKOM）评估临床表现。采用中位数四分位回归进行分析。所有患者均观察到软骨病变、软骨下骨磨损和骨赘。60%的患者观察到骨髓病变（BML），55%的患者观察到滑膜炎。分别有 6%和 17%的患者观察到软骨下囊肿和韧带变化。患者疼痛严重程度与内侧软骨病变相关（系数 2.50，95%置信区间 0.61-4.40，p<0.01）。患者的 ADL 功能障碍与膝关节内侧的 BML 相关（0.82，0.21-1.02，p=0.04）。膝关节内侧的 BML 与早期内侧膝骨关节炎患者的 ADL 功能障碍相关。
