Bone marrow edema and its relation to progression of knee osteoarthritis
Bone marrow edema and its relation to progression of knee osteoarthritis
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DOI：
10.7326/0003-4819-139-5_part_1-200309020-00008
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发表时间：
2003-09-02
影响因子：
39.2
通讯作者：
Gale, D
中科院分区：
文献类型：
--
作者：
Felson, DT;McLaughlin, S;Gale, D
背景：虽然影响膝骨关节炎病程的因素大多未知，但骨扫描病变和机械排列不良会增加放射学恶化的风险。磁共振成像上的骨髓水肿病变与骨扫描病变相对应。目的：确定膝骨关节炎患者的关节下骨水肿病变是否会识别出放射学进展高风险的膝盖，以及这些病变是否与肢体排列不良相关。设计：自然历史研究。设置：马萨诸塞州波士顿退伍军人管理局医院。患者：个人 45 岁及以上，患有有症状的膝骨关节炎。测量：基线评估包括膝关节磁共振成像和荧光镜定位放射线摄影。在 15 个月和 30 个月的随访期间，患者接受了重复的 X 光检查； 15 个月时，获得长肢胶片以评估机械对准。进展被定义为基于半定量分级的内侧或外侧关节间隙变窄的随访增加。采用广义估计方程评估肢体排列调整前后内侧骨髓水肿病变与内侧进展以及外侧病变与外侧进展的关系。 结果：256 例患者中，223 例（87.1%）参加了至少一项随访检查。内侧骨髓病变多见于四肢内翻患者，外侧病变多见于四肢外翻患者。 75 个有内侧病变的膝关节中有 27 个（36.0%）显示出内侧进展，而 148 个无病变膝关节中有 12 个（8.1%）出现内侧进展（进展比值比为 6.5 [95% Cl，3.0 至 14.0]）。大约 69% 向内侧进展的膝关节存在内侧病变，而外侧病变则具有显着的横向进展风险。调整肢体排列后，这些增加的风险减弱了 37% 至 53%。 结论：骨髓水肿是膝骨关节炎结构恶化的一个潜在危险因素，其与进展的关系部分是通过其与肢体排列的关系来解释的。
Background: While factors affecting the course of knee osteoarthritis are mostly unknown, lesions on bone scan and mechanical malalignment increase risk for radiographic deterioration. Bone marrow edema lesions on magnetic resonance imaging correspond to bone scan lesions.Objective: To determine whether edema lesions in the subarticular bone in patients with knee osteoarthritis identify knees at high risk for radiographic progression and whether these lesions are associated with limb malalignment.Design: Natural history study.Setting: A Veterans Administration hospital in Boston, Massachusetts.Patients: Persons 45 years of age and older with symptomatic knee osteoarthritis.Measurements: Baseline assessments included magnetic resonance imaging of the knee and fluoroscopically positioned radiography. During follow-up at 15 and 30 months, patients underwent repeated radiography; at 15 months, long-limb films were obtained to assess mechanical alignment. Progression was defined as an increase over follow-up in medial or lateral joint space narrowing, based on a semi-quantitative grading. Generalized estimating equations were used to evaluate the relation of medial bone marrow edema lesions to medial progression and lateral lesions to lateral progression, before and after adjustment for limb alignment.Results: Of 256 patients, 223 (87.1%) participated in at least one follow-up examination. Medial bone marrow lesions were seen mostly in patients with varus limbs, and lateral lesions were seen mostly in those with valgus limbs. Twenty-seven of 75 knees with medial lesions (36.0%) showed medial progression versus 12 of 148 knees without lesions (8.1%) (odds ratio for progression, 6.5 [95% Cl, 3.0 to 14.0]). Approximately 69% of knees that progressed medially had medial lesions, and lateral lesions conferred a marked risk for lateral progression. These increased risks were attenuated by 37% to 53% after adjustment for limb alignment.Conclusion: Bone marrow edema is a potent risk factor for structural deterioration in knee osteoarthritis, and its relation to progression is explained in part by its association with limb alignment.