Larger bone marrow lesion volume before medial open-wedge high tibial osteotomy correlates with better improvement of clinical scores in patients with knee osteoarthritis
Larger bone marrow lesion volume before medial open-wedge high tibial osteotomy correlates with better improvement of clinical scores in patients with knee osteoarthritis
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内侧开放楔形高位胫骨截骨术前骨髓病变体积较大与膝骨关节炎患者临床评分的更好改善相关
DOI：
10.1007/s00167-022-07134-9
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Matsuda Shuichi
中科院分区：
文献类型：
--
作者：
Yabe Taisuke;Nishitani Kohei;Yoshida Shigeo;Yamawaki Yusuke;Morita Yugo;Kobori Yu;Nakamura Shinichiro;Kuriyama Shinichi;Matsuda Shuichi
目的评价胫骨内侧切开楔形高位截骨术(MOWHTO)的临床疗效和骨髓损伤(BML)评分及体积。这些假设是定量的BML体积比定性的BML评估更能反映MOWHTO的临床结果，并且术前BML体积与临床结果的改善有关。在初次手术前和钢板取出手术时记录膝关节损伤和骨关节炎结果评分(KOOS)。术前采用短时反转恢复磁共振成像，用3个定性评分评价BMLS，反映BML的最大长度、比例和强度。为了定量，将股骨和胫骨的BMLS分别定义为阈值大于平均信号强度加两个标准差的病变，并以相应的外侧髁作对照。采用Spearman相关系数评价Koos评分与BML积分/体积之间的相关性。将胫骨BML体积作为4个自变量之一，对术后Koos评分进行多元线性回归分析。结果最终纳入40例MOWHTO病例。两个定性的BML评分只与手术前的Koos运动相关。股骨和胫骨骨髓体积分别与术后Koos生活质量(ρ= 0.40，p= 0.01)和运动(ρ= 0.36，p= 0.02)相关。胫骨骨髓体积与所有5种Delta Koos评分均显著相关(ρ= 0.39~0.51，p= 0.01~0.001)，而股骨骨髓体积仅与Delta Koos生存质量相关(ρ= 0.41，p= 0.01)。在多因素分析中，胫骨BML体积对术后所有Koos评分均有显著正向预测作用，而术后%机械轴值也是除术后Koos疼痛外的显著正相关变量。结论胫骨BML体积与术后1个Koos评分和所有Delta Koos评分呈正相关。术前较大的胫骨BML和适当的对齐矫正与术后较好的Koos评分相关。术前大的BML对术后的临床结果没有负面影响，因此，对于内侧的大BMLS的患者，外科医生可以毫不犹豫地实施MOWHTO。证据水平回顾病例系列，IV级。
AbstractPurposeThis study evaluated the clinical outcomes of medial open‐wedge high tibial osteotomy (MOWHTO) and bone marrow lesion (BML) scores and volumes. The hypotheses were that quantitative BML volume is more associated with clinical outcomes of MOWHTO than qualitative BML evaluations, and pre‐operative BML volume is associated with the improvement of clinical outcomes.MethodsPatients who underwent MOWHTO were retrospectively enrolled. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was recorded before the initial surgery and at plate removal surgery. Using pre‐operative short‐time inversion recovery magnetic resonance imaging, BMLs were evaluated using three qualitative scores, reflecting the maximum length, proportion, and intensity of BML. For quantification, BMLs of the femur and tibia were separately defined as lesions with a threshold greater than the mean signal intensity plus two standard deviations, using the corresponding lateral condyles as controls. The association between the KOOS scales and BML scores/volume was evaluated using Spearman’s correlation coefficient. Multivariate linear regression analyses for post‐operative KOOS scales were performed using the tibial BML volume as one of the four independent variables.ResultsThe final analysis included 40 MOWHTO cases. Two qualitative BML scores correlated only with pre‐operative KOOS sports. Femoral and tibial BML volumes were correlated with post‐operative KOOS QOL (ρ= 0.40,p= 0.01) and sports (ρ= 0.36,p= 0.02), respectively. Tibial BML volume was significantly correlated with all five delta KOOS scales (ρ= 0.39–0.51,p= 0.01–0.001), however, femoral BML volume was only correlated with delta KOOS QOL (ρ= 0.41,p= 0.01). In multivariate analyses, tibial BML volume was a significant positive predictor for every post‐operative KOOS scale, while post‐operative % mechanical axis was also a positive significant variable, except post‐operative KOOS pain.ConclusionTibial BML volume was positively correlated with one post‐operative KOOS scale and all delta KOOS scales. A larger pre‐operative tibial BML and appropriate alignment correction were associated with a better post‐operative KOOS scales. Pre‐operative large BML had no negative influence on post‐operative clinical outcomes; hence, surgeons need not hesitate to perform MOWHTO in patients with large BMLs in the medial condyles.Level of evidenceRetrospective case series, Level IV.
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影响因子：
3.8
作者：
Takeuchi, Ryohei;Aratake, Masato;Saito, Tomoyuki
通讯作者：
Saito, Tomoyuki
骨髓病变的频率及其与疼痛严重程度的关联：基于人群的症状性膝关节队列的结果
DOI：
10.3899/jrheum.100587
发表时间：
2011
期刊：
The Journal of Rheumatology
影响因子：
--
作者：
Stephen Ip;E. C. Sayre;A. Guermazi;S. Nicolaou;H. Wong;Anona Thorne;J. Singer;J. Kopec;J. Esdaile;J. Cibere
通讯作者：
J. Cibere
影响因子：
2.3
作者：
Nielsen FK;Egund N;Peters D;Jurik AG
通讯作者：
Jurik AG
影响因子：
7
作者：
Sowers, MF;Hayes, C;Welch, G
通讯作者：
Welch, G
DOI：
10.1007/s00167-021-06717-2
发表时间：
2022-03
期刊：
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
影响因子：
--
作者：
Schelker BL;Moret CS;Dogan O;Amsler F;Rasch H;Hügli RW;Hirschmann MT
通讯作者：
Hirschmann MT