【作者】 寒桦；

【导师】 卫小春；

【作者基本信息】 山西医科大学 ， 骨外科学， 2010， 硕士

【摘要】 研究背景：膝关节内损伤指涉及关节结构的骨、软骨和关节内软组织包括韧带、软骨、滑膜等的急性或慢性损伤。关节内组织受到的机械应力主要有压缩应力,拉伸应力,切应力和流体静压力。膝关节内损伤主要是由于机械应力分布失衡或负载过度引起软骨磨损所致。膝关节镜手术是一种微创有效的外科手段,在关节镜下对软骨及滑膜损伤程度进行的评分,最直接、准确而且全面地反映了关节内部病情发展情况。已有许多实验证实肥胖与膝关节骨关节炎(osteoarthritis, OA)之间存在关联,涉及与OA的影像学改变,症状严重度,生化代谢改变等等之间的关系研究,而肥胖,作为一个导致膝关节退行性病变或创伤病变的危险因素,与在关节镜下肉眼观察到的软骨滑膜损伤程度的关联性如何,即为本研究的目的所在。本研究旨在评估其与关节软骨滑膜损伤严重程度的关联,从诊断疾病量化程度的金标准出发来验证BMI指数与疾病程度的关联。此研究对合理评估膝关节内损伤严重度及发生OA的危险性有一定的指导价值。目的：探讨反映肥胖程度的BMI指数与关节镜下观察到的软骨损伤、滑膜炎症程度之间的联系,评估其与关节疾病严重程度的关联,从诊断疾病量化程度的金标准出发来验证BMI指数与疾病程度的关联。另外通过对比各年龄段中健康体检组与行关节镜手术治疗组人群之间BMI指数的差异,分析肥胖对罹患膝关节内损伤疾病的影响力。方法：收集2009年5月至2009年9月在山西医科大学第二医院骨科行关节镜诊治的膝关节疾病患者109例,年龄18岁-77岁,平均38岁,男57膝,女52膝。选取178名在山西医科大学第二临床医院体检中心进行体检的无关节疾患人群,年龄在18岁-65岁之间,平均38岁,男111例,女67例。对109名在山西医科大学第二临床医院行关节镜手术的患者在入院后术前进行问诊查体及读片,获得患者身体质量指数(Body Mass Index, BMI)指数数据并登记整理。患者行关节镜手术时评估并登记Outerbridge软骨评分、Ayral滑膜炎评分。对178名在山西医科大学第二临床医院体检中心进行体检诊断无关节疾患的患者进行体检问诊,获得患者BMI指数数据并登记整理。然后将数据用方差分析、spearman相关分析进行统计分析,探讨之间的联系。结果：109名膝关节疾病患者BMI指数与Outerbridge软骨损伤累计评分呈正相关(r=0.58,p<0.01),BMI正常组,BMI超重组,BMI肥胖组各分组间两两比较,差别有统计学意义(p<0.01),并且三组间Outerbridge软骨损伤累计评分呈逐级递增趋势。109名膝关节疾病患者BMI指数与Outerbridge软骨损伤最高评分呈正相关(r=0.70,p<0.01),BMI正常组,BMI超重组,BMI肥胖组各分组间两两比较,差别有统计学意义(p<0.01),并且三组间Outerbridge软骨损伤最高评分呈逐级递增趋势。109名膝关节疾病患者BMI指数与Ayral滑膜炎评分呈正相关(r=0.47,p<0.01),BMI正常组,BMI超重组,BMI肥胖组各分组间两两比较,差别有统计学意义(p<0.01),并且三组间Ayral滑膜炎评分呈逐级递增趋势。将行关节镜手术患者以及体检无膝关节疾病患者分别按照年龄分为四段：第一段,年龄在18岁至28岁之间；第二段,年龄在29岁至39岁之间；第三段,年龄在40岁至50岁之间；第四段,年龄在51岁以上。各组内年龄与Outerbridge软骨损伤累计评分及Ayral滑膜炎评分不相关(p>0.05)。第一年龄段中关节镜组患者BMI与体检组患者BMI无显著差别(p>0.05)；第二、三、四年龄段中关节镜组患者BMI显著高于体检组患者BMI(p<0.05)。结论：肥胖程度对软骨损伤程度以及滑膜炎症程度有较大的影响,尤其表现在对软骨局部损伤程度的影响,可能说明BMI对关节内损伤所产生的影响大部分取决于肢体对位关系的改变。29岁以上的同年龄段人群,随着肥胖程度的增高而导致发生关节内损伤危险性的增高。18至28岁年龄段人群,关节内损伤危险性不会随着肥胖程度的增高发生改变。可能是由于青年人参加运动的强度与频度明显高于中老年人,经历运动或暴力损伤的几率更高,而且自身肌肉韧带与关节囊等软组织韧性大,强度较高,关节内软骨修复能力尚佳,因而导致损伤的原因绝大部分归因于运动或暴力损伤本身,相比较就同肥胖程度关联不是很大。更多还原

【Abstract】 Background:The damage within the knee joint involvs the acute and chronic injury of bone,cartilage which make up the structure of joint and parenchyma including ligament, synovium,cartilage and so on in joint. The mechanical stress intra-articular tissue bear is mainly made up of compression stress, tensile stress, shear stress and fluid static pressure. The injury within the knee is mainly due to mechanical stress distribution imbalance or excessive load which cause cartilage wear. Kneed arthroscope surgery is a minimally invasive and effective surgical method, the most direct, precise reflect can be shown under the arthroscope including the chondral and synovial damage degree of grading, and the development of the internal condition. Many experiments have confirmed the relationship between the obesity and knee osteoarthritis (OA), involves the progress of X-ray results, the severity of symptoms, and biochemical metabolic changes, etc. Whether the obesity, the risk factor which cause joint degenerative diseases or traumatic diseases, is correlative with the arthroscopic macroscopic observation of chondrol and synovial injury or not, is the purpose of this study. This study aims to evaluate the relationship between the gold standard of diagnosis and BMI. The study have guiding values on reasonable assessment of the injury severity within the knee and the risk of OA.Objectives:To evaluate the correlation between BMI and the damage degree of arthroscopic macroscopic observation of chondrol and synovial injury,to evaluate the relationship between the gold standard of diagnosis and obesity. By comparing BMI differences between the different age brackets of healthy kneed group and arthroscopic surgery treatment group to analyse influence of obesity on injury in knee joint.Methods:109 patients with knee joint diseases operated under the arthroscope in shanxi medical university 2nd hospital during the may,2009 to the september 2009, aged 18-77,38 on average, involves 57 male and 52 female.178 people received physical examination in clinical check-up center of shanxi medical university 2nd hospital whose knees have been diagnosed healthy, aged 18-65,38 on average, involves 111 male and 67 female. All people’s BMI are calculated. The degree of patients’cartilage injury was assessed with Outerbridge’s score system under arthroscope,the degree of patients’synovitis was assessed with Ayral’score system under arthroscope.The data are analyzed by the analysis of variance and Spearman correlation.Results:The results show that BMI of 109 patients with knee joint diseasese are positively related with cumulative Outerbridge’s score(r=0.58, p< 0.01), with Outerbridge’s top score (r=0.70, p <0.01), with Ayral’s score(r=0.47, p< 0.01). The pairwise comparison among three BMI groups show that the differences were statistically significant (p< 0.01). The arthroscopic surgery patients and people without knee diseases are divided respectively according to age into four sections:the first section, aged 18 to 28; The second section, aged 29 to 39, The third section, aged 40 to 50, The fourth section, aged above 51 years old. Within each age section BMI and cumulative Outerbridge’s score and Ayral s’s score are not related(p> 0.05). In the first age section BMI of arthroscopy group patients are associated with no significant difference with BMI of people without knee diseases(p> 0.05). In the second, third, fourth age section, BMI of arthroscopy group patients have significantly higher BMI than that of people without knee diseases (p<0.05).Conclusion:Obese degree are related with the degree of cartilage injury and synovitis.Obesity has great influence on cartilage, especially on the local damage degree, which indicate that the effect of obesity on the joint may depends largely on the change of body alignment. In the age sections above 29 years old, the risk of damage occurred within the joints raise with increasing obese degree.While in the section aged 18 to 28 show no significant difference(p> 0.05). It may be due to the strength and the sport of youngsters are obviously higher than in the elderly,they experience the higher frequency of injury or violent motion, and their muscles, ligaments, soft capsule have higher strength and toughness,and have strong repair ability of joint cartilage.The damage are most attributed to exercise or violent damage themselves, compared with them obesity dose not have strong association.更多还原