基于定量CT分析膝骨关节炎退变性软骨损伤及骨髓水肿与骨质疏松的相关性OA
Correlation analysis of degenerative cartilage injury and bone marrow edema with osteoporosis in knee osteoarthritis based on quantitative CT
目的:通过定量CT(quantitative CT,QCT)研究膝骨关节炎患者软骨损伤、骨髓水肿与骨质疏松的相关性.方法:回顾性分析2020年1月至2022年12月86例膝骨关节炎患者胸部CT资料,并收集临床资料,其中男23例,女63例,年龄42～74(57.72±7.97)岁.使用QCT测量患者T12、L1椎体骨密度(bone mineral density,BMD);软骨损伤根据Outerbridge标准分级将患者分为软骨损伤2、3、4级;并通过膝MRI判断患者有无骨髓水肿.比较软骨损伤各级之间BMD的差异,并进行相关性分析及偏相关分析;比较骨质疏松发生率在有、无骨髓水肿组间的差异,并分析各骨密度值与骨髓水肿的相关性.结果:不同软骨损伤级别间年龄,T12、L1 BMD,骨质疏松发生率差异有统计学意义(P＜0.001);2级和3级、2级和4级骨密度值比较,差异有统计学意义(P＜0.001);3、4级骨密度值比较,差异无统计学意义(P＞0.05);软骨损伤程度与 T12、T12＊、L1 BMD、M-BMD 均呈负相关(r 值分别为-0.377、-0.382、-0.437、-0.407,P＜0.001),控制年龄、BMI和性别混杂因素偏相关分析后得出软骨损伤程度与M-BMD仍呈一定负相关(r=-0.210,P=0.033).有骨髓水肿患者骨质疏松发生率高于无骨髓水肿患者,骨髓水肿与T12、T12＊BMD、M-BMD均呈负相关(r值分别为-0.242、-0.246、-0.208、-0.227,P＜0.05).结论:在膝骨关节炎患者中,随着软骨损伤程度的增加,T12、L1 BMD逐渐减低,骨质疏松发生率逐渐升高;有骨髓水肿的KOA患者的T12、L1 BMD要低于无骨髓水肿的KOA患者.
Objective To investigate the correlation between cartilage injury,bone marrow edema and osteoporosis in pa-tients with knee osteoarthritis(KOA)using quantitative computed tomography(QCT).Methods A retrospective analysis was performed on chest CT and clinical data of 86 patients with LOA between January 2020 and December 2022.The patients in-cluded 23 males and 63 females,aged from 42 to 74 years with a mean age of(57.72±7.97)years.Bone mineral density(BMD)of T12 and L1 vertebrae was measured using QCT.According to Outerbridge classification,patients were graded into grade 2,grade 3,and grade 4 cartilage injury.Bone marrow edema was evaluated on knee MRI.The differences in BMD among different grades of cartilage injury were compared,and correlation analysis and partial correlation analysis were performed.The incidence of osteoporosis was compared between groups with and without bone marrow edema,and the correlation between BMD values and bone marrow edema was analyzed.Results There were statistically significant differences in age,T12 and L1 BMD,and the incidence of osteoporosis among different cartilage injury grades(P＜0.001).Statistically significant differences were observed in BMD between grade 2 and grade 3,and between grade 2 and grade 4(P＜0.001),while no significant differ-ence was found between grade 3 and grade 4(P＞0.05).The severity of cartilage injury was inversely correlated with T12,T12＊,L1 BMD,and M-BMD,with r values of-0.377,-0.382,-0.437,and-0.407,respectively(all P＜0.001).After adjusting for con-founding factors including age,BMI,and gender using partial correlation analysis,the severity of cartilage injury still showed a certain inverse correlation with M-BMD(r=-0.210,P=0.033).The incidence of osteoporosis was higher in patients with bone marrow edema than in those without bone marrow edema.Bone marrow edema was inversely correlated with T12,T12＊ BMD,and M-BMD,with r values of-0.242,-0.246,-0.208,and-0.227,respectively(all P＜0.05).Conclusion In patients with KOA,T12 and L1 BMD gradually decreased and the incidence of osteoporosis gradually increased with the worsening of cartilage injury.T12 and L1 BMD were lower in KO A patients with bone marrow edema than in those without bone marrow edema.
朱宁;翟建
皖南医学院第一附属医院影像中心,安徽 芜湖 241001皖南医学院第一附属医院影像中心,安徽 芜湖 241001
医药卫生
膝关节定量CT骨密度软骨损伤骨髓水肿
Knee jointQuantitative computed tomography(QCT)Bone mineral density(BMD)Cartilage in-juryBone marrow edema
《中国骨伤》 2026 (4)
349-354,6
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