Xiao Long-Wen, Sang Zhi-Cheng
Fengsheng Special Hospital of Orthopaedics and Traumatology, Beijing 100033, China; The Second Department of Orthopaedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China.
The Second Department of Orthopaedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China.
Zhongguo Gu Shang. 2023 Apr 25;36(4):371-5. doi: 10.12200/j.issn.1003-0034.2023.04.014.
To explore relationship between bone marrow edema(BME) and osteoporosis in patients with severe knee osteoarthritis.
Unmatched case-control study was conducted. Totally 160 patients with severe knee osteoarthritis who had undergone knee magnetic resonance imaging (MRI) and bone mineral density examination (BMD) from January 2020 to March 2021 were included. Eighty patients complicated with BME were included in BME group, and 80 patients without BME were selected as NBME group. In BME group, there were 12 males and 68 females, aged from 51 to 80 years old with an average of(66.58±8.10) years old;the courses of disease ranged from 5 to 40 months with an average of (15.61±9.25) months;body mass index(BMI) ranged from 21.81 to 34.70 with an average of (27.79±3.00) kg·m;25 patients classified to grade Ⅲ and 55 patients grade Ⅳ according to Kellgren- Lawrence(K-L). In NBME group, there were 15 males and 65 females, aged from 50 to 80 years old with an average of(67.82±8.05) years old;the course of disease ranged from 6 to 37 months with an average of(15.75±8.18) months;BMI ranged from 21.39 to 34.46 with an average of (28.26±3.13) kg·m;25 patients were K-L Ⅲ and 55 patients with K-L Ⅳ. The degree of bone marrow edema was evaluated by knee whole oragan magnetic resonance imaging score(WORMS). Osteoporosis was diagnosed and BMD was evaluated by DXA T value. To explore the relationship between bone marrow edema and osteoporosis by comparing prevalence rate of osteoporosis between two groups, and to further explore relationship between BME and BMD by Spearman correlation analysis of BME WORMS score and DXA T value in BME group.
The complete case data were obtained on the first diagnosis, and there was no significant difference in sex, age, courses of disease and BMI between two groups (>0.05). The proportion of K-L Ⅳ in BME group was significantly higher than that in NBME (<0.05). The prevalence rate of osteoporosis in BME group was significantly higher than in NBME group with the same K-L grade (<0.001), and there was a strong negative correlation between BME WORMS score and DXA BMD T value (=-0.812, ||=0.812 >0.8, <0.001).
Osteoporosis is one of the risk factors of bone marrow edema in patients with severe knee osteoarthritis, and the lower the bone mineral density is, the easier it is to be complicated with bone marrow edema.
探讨重度膝关节骨关节炎患者骨髓水肿（BME）与骨质疏松症之间的关系。
采用非匹配病例对照研究。纳入2020年1月至2021年3月期间接受膝关节磁共振成像（MRI）和骨密度检查（BMD）的160例重度膝关节骨关节炎患者。BME组纳入80例合并BME的患者，80例未合并BME的患者被选为非BME组。BME组中，男性12例，女性68例，年龄51至80岁，平均（66.58±8.10）岁；病程5至40个月，平均（15.61±9.25）个月；体重指数（BMI）21.81至34.70，平均（27.79±3.00）kg·m²；根据Kellgren-Lawrence（K-L）分级，25例为Ⅲ级，55例为Ⅳ级。非BME组中，男性15例，女性65例，年龄50至80岁，平均（67.82±8.05）岁；病程6至37个月，平均（15.75±8.18）个月；BMI 21.39至34.46，平均（28.26±3.13）kg·m²；25例为K-LⅢ级，55例为K-LⅣ级。采用膝关节全器官磁共振成像评分（WORMS）评估骨髓水肿程度。通过双能X线吸收法（DXA）T值诊断骨质疏松症并评估骨密度。通过比较两组骨质疏松症患病率探讨骨髓水肿与骨质疏松症之间的关系，并通过对BME组BME WORMS评分与DXA T值进行Spearman相关分析进一步探讨BME与骨密度之间的关系。
首次诊断时获得完整病例数据，两组在性别、年龄、病程和BMI方面无显著差异（>0.05）。BME组K-LⅣ级的比例显著高于非BME组（<0.05）。BME组中相同K-L分级的骨质疏松症患病率显著高于非BME组（<0.001），且BME WORMS评分与DXA骨密度T值之间存在强负相关（r=-0.812，|r|=0.812>0.8，P<0.001）。
骨质疏松症是重度膝关节骨关节炎患者骨髓水肿的危险因素之一，骨密度越低，越容易合并骨髓水肿。
