Güneş Seçilay, Şehim Kutlay, Cüneyt Köksoy, Gökmen Derya, Küçükdeveci Ayşe Adile
Department of Physical Medicine and Rehabilitation, Ankara University School of Medicine, Ankara, Turkey.
Department of Surgery, Division of Vascular Surgery, Ankara University School of Medicine, Ankara, Turkey.
Turk J Phys Med Rehabil. 2020 Mar 3;66(1):40-46. doi: 10.5606/tftrd.2020.5110. eCollection 2020 Mar.
This study aims to evaluate whether there is a relationship between venous insufficiency (VI) and knee osteoarthritis (OA).
Between February 2012 and May 2013, a total of 206 knees of 103 participants (14 males, 89 females; mean age 48.6±8.6 years; range, 30 to 69 years) were enrolled. The study group included 59 patients who were diagnosed with knee OA and the control group included 44 healthy volunteers without any complaint in their knee joints. Demographic and clinical characteristics of all participants were recorded. Venous system of the lower extremities was evaluated by Doppler ultrasonography. All knees were evaluated using conventional radiography based on the Kellgren-Lawrence (K&L) grading system and ultrasonography. Pain severity was evaluated using Likert pain scale and functioning was evaluated using Western Ontorio and McMaster Universities Osteoarthritis Index (WOMAC).
Venous insufficiency was detected in 40.6% of the OA group and 15.9% of the control group (p=0.007). There was no statistically significant difference in the cartilage thicknesses and K&L grading regarding the presence of VI (p>0.05); however, the percentage of the radiographic medial tibial sclerosis was higher in patients with VI (60%) in the OA group (p>0.05). The WOMAC total scores were similar in both groups, while the WOMAC pain scores were higher in the patients with deep VI (p>0.05).
Increased radiographic medial tibial sclerosis and higher WOMAC pain scores in patients with venous involvement in OA may lead to the hypothesis that venous system pathologies can affect the intraosseous microenvironment of the bone, resulting in pain and early subchondral bone involvement, consequently presenting as subchondral sclerosis.
本研究旨在评估静脉功能不全（VI）与膝关节骨关节炎（OA）之间是否存在关联。
在2012年2月至2013年5月期间，共纳入103名参与者的206个膝关节（14名男性，89名女性；平均年龄48.6±8.6岁；范围为30至69岁）。研究组包括59例被诊断为膝关节OA的患者，对照组包括44名膝关节无任何不适的健康志愿者。记录所有参与者的人口统计学和临床特征。通过多普勒超声评估下肢静脉系统。所有膝关节均使用基于Kellgren-Lawrence（K&L）分级系统的传统X线摄影和超声进行评估。使用Likert疼痛量表评估疼痛严重程度，并使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评估功能。
OA组中40.6%检测到静脉功能不全，对照组中为15.9%（p = 0.007）。关于VI的存在，软骨厚度和K&L分级无统计学显著差异（p>0.05）；然而，OA组中存在VI的患者放射学内侧胫骨硬化的百分比更高（60%）（p>0.05）。两组的WOMAC总分相似，而深部VI患者的WOMAC疼痛评分更高（p>0.05）。
OA患者中静脉受累时放射学内侧胫骨硬化增加和WOMAC疼痛评分更高，这可能导致这样的假设，即静脉系统病变可影响骨的骨内微环境，导致疼痛和早期软骨下骨受累，进而表现为软骨下硬化。
