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膝关节骨性关节炎中医辨证分型与MRI相关性研究

作者:李宝然

所属单位:辽宁中医药大学附属第二医院放射科(辽宁 沈阳 110034)

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摘要

目的探讨膝关节骨性关节炎 (KOA)的中医辨证分型与MRI表现的相关 性,为临床诊疗提供依据。方法 对我 院72例KOA患者进行中医辨证分型:筋 脉瘀滞型(22例),湿注骨节型(23例) 和痰瘀交阻型(27例)。然后进行MRI检 查,分析3种证型与各种MRI表现之间的 相关性。结果 72例患者均发生关节软 骨及半月板损伤;滑膜增厚以湿注骨节 型发生率最高(86.96%),与筋脉瘀滞型 和痰瘀交阻型比较差异有统计学意义(P <0.01);骨质增生以痰瘀交阻型发生率 最高(85.2%),与筋脉瘀滞型和湿注骨节 型比较差异有统计学意义(P<0.01);关 节游离体形成以痰瘀交阻型发生率最高 (37.0%),与筋脉瘀滞型比较差异有统计 学意义(P<0.05)。结论 KOA中医证型 与MRI表现有一定的相关性,MRI在一定 程度上可以作为不同中医证型的辨证参 考。

Objective To explore the correlation between TCM syndrome differentiation types of knee osteoarthritis (KOA) and its MRI changes,so as to provide evidence for clinical diagnosis and treatment. Methods According to the standards of diagnosis and treatment based on overall analysis of symptoms and signs of TCM,72 patients with KOA were divided into 3 types:type of stagnation of tendons and muscles (22 cases),type of dampness infusion into bone and joints (23 cases) and type of inter-obstruction of phlegm and stasis (27 cases).All patients were performed MRI examination, in order to find out the correlation between syndrome differ classification of KOA and its MRI changes. Results 72 cases occurred with articular cartilage and meniscus injury.The incidence of synovial thickening of type of dampness infusion into bone and joints was the highest among the three types (P<0.01).The incidence of bone hyperplasia of type of inter-obstruction of phlegm and stasis was the highest among the three types (P<0.01).The incidence of joint free body formation of type of inter-obstruction of phlegm and stasis was the highest among the three types (P<0.05). Conclusion There is certain correlation between TCM syndrome differentiation types of KOA and its MRI changes.MRI could be used as a reference for different types of TCM syndromes.

【关键词】膝关节骨性关节炎;中医辨证分型;MRI表现

【中图分类号】R445.2;R684

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2015.10.031

前言

膝关节骨性关节炎(knee osteoarthritis,KOA)是一种退行性关节 疾病,多发于中老年人群。中医治疗KOA具有较好的疗效[1],辨证施治 是中医治病的基本原则,能否准确辨证分型是该病治疗的关键,“望 闻问切”等传统诊疗模式已不能满足现代医学诊断发展的需求。MRI是 目前KOA诊断最常用也是最有效的辅助手段[2],如何将MRI等现代医学 检查手段合理地纳入到中医的辨证施治体系当中,是中医现代化、国 际化的的重要课题。本研究探索性地将不同证型KOA患者的MRI影像学 特征进行分析,试图找出中医辨证分型与MRI表现的内在联系,为中医 辨证规范化提供参考。