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| 软骨下骨在膝骨关节炎不同阶段变化及早期预测价值 |
| The change of subchondral bone in different stages of knee osteoarthritis and its early predictive value |
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| DOI：10.3969/j.issn.1006-7108.2026.05.011 |
| 中文关键词: 骨关节炎 膝关节 骨密度 影像诊断 |
| 英文关键词:osteoarthritis knee joint bone mineral density radiographic diagnosis |
| 基金项目:广州市科技局重点研发计划项目(202206010048)；“广东特支计划”省卫生健康委领军人才项目[粤卫人函(2024)54号]；广州地区中西医协同临床重大创新技术建设项目[穗卫函(2023)2318号]；广州市科技局基础与应用基础研究项目（202201011291）；广东省中医药局专项研究项目（20223004） |
| 作者 | 单位 | | 章家皓1 陈佳浩1 胡青松2,3,4 李易妍5 刘文刚2,3,4 陈文静2,3,4 赵传喜2,3,4 许学猛2,3,4* | 1 广州中医药大学第五临床医学院,广东 广州 510000
2 广东省第二中医院,广东 广州 510000
3 广东省中医药工程技术研究院,广东 广州 510000
4 广东中医药研究开发重点实验室,广东 广州 510000
5 广州中医药大学第一临床医学院,广东 广州 510000 |
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| 中文摘要: |
| 目的 软骨退化既往被认为是膝骨关节炎（knee osteoarthritis，KOA）进展的主要因素。然而，软骨下骨变化在KOA的进展中同样起着重要作用。如何检测软骨下骨骨质差异以及利用软骨下骨骨质参数预测早期KOA的发生，对延缓KOA的进展具有重要意义。方法 本研究为单中心回顾性研究，经过样本量计算后，收集2020年1月至2023年12月广东省第二中医院收治的104位患者一般资料（年龄、性别、侧别、骨密度）、膝关节X光片和CT影像，分成正常组、早期KOA组、晚期KOA组。使用Mimics软件测量胫骨软骨下骨的CT值，并通过公式计算骨密度和弹性模量。采用单因素方差分析（ANOVA）确定不同阶段KOA患者软骨下骨骨质参数的差异。通过单变量和多变量逻辑回归分析确定早期KOA的风险因素。使用受试者工作特征（ROC）曲线分析确定软骨下骨内侧和外侧骨密度的敏感性、特异性及临界值。结果 三组的内侧和外侧软骨下骨的CT值、骨密度和弹性模量的变化趋势均呈现先下降后上升的趋势。逻辑回归分析和ROC曲线结果显示，内侧骨密度? 329.5 g/cm3和外侧? 310.2 g/cm3与早期KOA的发生显著相关。结论 KOA患者软骨下骨骨质的变化表现为从骨量减少再到骨硬化的过程。软骨下骨的内侧和外侧骨密度对早期KOA发生的预测具有重要意义。 |
| 英文摘要: |
| Objective Cartilage degeneration has previously been recognized as a major factor in the progression of knee osteoarthritis (KOA). However, subchondral bone changes play an equally important role in the progression of KOA. The detection of subchondral bone differences and the prediction of early KOA using subchondral bone parameters are important to slow down the progression of KOA. Methods A single-center retrospective study was conducted. After sample size calculation, general data (age, gender, side, bone mineral density), knee X-rays, and CT images of 104 patients from January 2020 to December 2023 were collected and divided into a normal group, an early KOA group, and an advanced KOA group. Mimics software was used to measure the CT values of the tibial subchondral bone, and bone mineral density and elastic modulus were calculated via formulas. One-way analysis of variance (ANOVA) was used to determine differences in subchondral bone parameters among patients at different KOA stages. Univariate and multivariate logistic regression analyses were performed to identify risk factors for early KOA. Receiver operating characteristic (ROC) curve analysis was used to determine the sensitivity, specificity, and cutoff values for medial and lateral subchondral bone density. Results The trends of CT values, bone mineral density, and elastic modulus in both the medial and lateral subchondral bone across the three groups showed an initial decrease followed by an increase. Logistic regression analysis and ROC curve results indicated that a medial bone density < 329.5 g/cm3 and a lateral bone density < 310.2 g/cm3 were significantly associated with the occurrence of early KOA. Conclusion Changes in subchondral bone in patients with KOA show a progression from reduced bone mass to osteosclerosis. The medial and lateral bone mineral density of the subchondral bone is important in the prediction of early KOA development. |
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