肌骨超声检查联合软骨代谢标志物与膝骨关节炎合并软骨损伤的相关性分析OA

Objective:To explore the diagnostic value of mus-culoskeletal ultrasound(MSUS)combined with cartilage metabolism markers for cartilage injury in knee osteoarthritis(KOA)and to investigate its correlation with disease severity.Methods:A retrospective analysis was conducted on the data of 96 patients with symptomatic KOA from May 2022 to April 2025.According to the arthroscopic examination results obtained after admission,they were divided into the group with cartilage injury(n=45)and the group with simple KOA(n=51).The morphology of femoral trochlear cartilage,the depth of suprapatellar bursa effusion,synovial blood flow signals and the formation of osteophytes at the femoral con-dyle/tibial plateau were assessed semi-quantitatively using MSUS examination,and the total scores of MSUS were calcu-lated.The levels of serum type Ⅱ collagen carboxyl-terminal peptide(CTX-Ⅱ),cartilage oligomeric matrix protein(COMP),and matrix metalloproteinase-3(MMP-3)were determined by ELISA.Univariate and multivariate Logistic regression analyses were conducted to identify factors associated with KOA complicated by cartilage injury.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of musculoskeletal ultrasound combined with cartilage metabolic markers for KOA with concurrent cartilage injury.All patients underwent arthroscopic examina-tion after admission.The severity of cartilage injury was evaluated using the Outerbridge classification.Grade Ⅰ and Ⅱwere defined as mild injury(n=23),grade Ⅲ as moderate injury(n=14),and grade Ⅳ as severe injury(n=8).To ana-lyze the correlation between the total scores of MSUS and cartilage metabolism markers and the severity of cartilage injury in patients with KOA.Results:The cartilage morphology,effusion depth,synovial blood flow,osteophyte scores and total MSUS scores in the combined cartilage injury group were significantly greater than those in the simple KOA group(P<0.05).The levels of serum CTX-Ⅱ,COMP and MMP-3 in the combined cartilage injury group were significantly higher than those in the simple KOA group(P<0.05).The total scores of MSUS and serum CTX-Ⅱ,COMP,and MMP-3 were identified as risk factors for KOA combined with cartilage injury(P<0.05).The area under the curve(AUC)of the combined diagnosis of musculoskeletal ultrasound and cartilage metabolism markers was significantly higher than that of individual indicators.Moreover,the more combined indicators there were,the higher the AUC.Among them,the total scores of MSUS+CTX-Ⅱ+COMP+MMP-3 had the highest diagnostic efficacy,with an AUC of 0.952,which was sig-nificantly higher than the diagnostic efficacy of the combination of two and three indicators(P<0.05).With the aggrava-tion of cartilage injury,the total scores of MSUS and the levels of serum CTX-Ⅱ,COMP,and MMP-3 all showed a gradu-ally increasing trend.Comparisons of the above indicators across different severity groups showed statistically significant differences(P<0.05).The total scores of MSUS and the levels of serum CTX-Ⅱ,COMP and MMP-3 were all signifi-cantly positively correlated with the Outerbridge grade(P<0.05).Conclusion:The morphology of femoral trochlear carti-lage,the depth of supatellar bursa effusion,synovial blood flow signals,osteophytes at the femoral condyle/tibial plateau,and the levels of serum cartilage metabolism markers in patients with KOA combined with cartilage injury are significantly changed com-pared with those with simple KOA.MSUS combined with cartilage metabolism markers exhibits high diagnostic value for KOA combined with cartilage injury and shows a significant correlation with the severity of cartilage injury.It can provide a reliable ba-sis for clinical diagnosis and treatment.