| Objective:Research the normal ultrasonic imaging characteristics of knee joint cartilage.Get the normal knee joint cartilage thickness and the distribution of cartilage thickness at different locations of bilateral knees.Compared the normal ultrasonography,summarized the ultrasoud manifestations of abnormal group.Analysis the correlation ralation of cartilage thickness of normal or abnormal group with relevant factors such as age,body mass,or body mass index(BMI)by SPSS 16.0 correlation analysis.Get the difference between the normal and abnormal groups.Discuss the influence factors of osteoarthritis(OA).Compared the diagnosis results of X ray and ultrasound.Proved that the high frequency ultrasound examination could apply to distinguish early cartilage lesions in OA effectively.Methods:Selected 61 healthy volunteers as normal group,selected 64 volunteers with knee althragia as abnormal group,and 2 healthy pig knee fresh specimens as the compare to normal group.Applied the GE voluson 730 SP6-12 high frequency ultrasound probe measured the thickness of three parts of bilateral femoral cartilage and both sides of bilateral tibial cartilage.Each part adopts three measuring average.The same method to mesure the pig knees' cartilage thickness.The abnormal group also took X ray knee examination.Statistical methods:Using SPSS 16.0 data analysis software,set P=0.05 as the test criterion,get Statistical average of the cartilage thickness,compare differencees of each part of cartilage thickness,analyzed the correlations between the cartilage thickness and some influence factors such as age,body mass or BMI using correlation analysis in both normal and abnormal group.Then analyze the ultrasonic images,get the characteristics of normal knee joint cartilage in ultrasound examination and get the characteristics of abnormal knee joint cartilage in ultrasound compared to the abnormal ones.Analyze the differences between the normal and abnormal group.Compared the postive rate of ultrasound and X ray in diagnosing abnormal group.Results:The average thickness of every part of the normal knee joint:right lateral femoral 0.24+/-0.05 cm,right medial femoral 0.26+/-0.05 cm,right inner femur 0.23+/-0.05 cm,right lateral tibia 0.19+/-0.06 cm,the right inner tibia 0.18+/-0.06 cm,left lateral femoral 0.23+/-0.04 cm,left inner femur 0.24+/-0.06 cm,left medial femur 0.25+/-0.05 cm,left inner tibia 0.19+/-0.06 cm,left lateral tibial 0.18+/-0.06 cmThe measurement results of pig knees using ultrasound were 0.25cm/0.23cm of lateral femur,0.20cm/0.18cm of intermediate femoral cartilage,0.27cm/0.25cm of inner femur,0.14cm/0.15cm of inner tibial cartilage,0.16cm/0.14cm of lateral tibial.And the results of pig knees cartilage thickness measured by vernier caliper were 0.26/0.22cm,0.21/0.19cm,0.29/0.25cm,0.12/0.15cm,0.15/0.15cm in corresponding points respectively.Ipsilateral Comparison of Healthy volunteers Group:the cartilaginous thickness of the lateral femur to the intermediate femur,right t=-4.274 P=0.000,left t=-4.261 P=0.000,the thickness of the lateral cartilages compared to the inner femur right t=-0.965 P=0.341,left t=1.095 P=0.281,the medial femur to the inner femur right t=-4.392 P=0.000,left t=-3.583 P=0.001,the inner tibial cartilage to lateral right t=-0.755 P=0.455,left t=1.973 P=0.056,the lateral femoral to the lateral tibial right t=6.169 P=0.000,left t=6.522 P=0.000,the inner femoral cartilage to the inner tibial cartilage right t=7.523 P=0.000,left t=4.386 P=0.000,the lateral femoral cartilage to that of the inner tibial cartilage right t=5.289 P=0.000,left t=4.666 P=0.000.The inner femoral cartilage was compared with that of the lateral tibial cartilage,right t=8.51 P=0.000,left t=6.312 P=0.000,the medial femoral cartilage to the lateral tibial cartilage right t=10.194 P=0.000,left t=8.458 P=0.000,the thickness of the medial femoral cartilage to the inner tibial cartilage right t=9.199 P=0.000,left t=6.982 P=0.000Ipsilateral Comparison of Abnormal Group:the thickness of the inner femoral cartilage to that of the lateral femoral cartilage t=0.864 P=0.401,left t=-0.545 P=0.594,the medial femoral to the lateral femoral cartilage right t=0.039 P=0.969,left t=4.523 P=0.000,the medial femoral cartilage to the inner femoral cartilage right t=0.525 P=0.607,left t=4.066 P=0.001,the lateral tibial cartilage to the inner tibial cartilage right t=-0.042 P=0.967,left t=-0.432 P=0.672,the latral femoral cartilage to the lateral tibial cartilage,right t=4.571 P=0.000,left t=4.484 P=0.000,the inner femoral cartilage to the inner tibial cartilage,right t=-5.248 P=0.000,left t=-1.809 P=0.091,the lateral femoral cartilage to the inner tibial cartilage right t=4.527 P=0.000,left t=2.802 P=0.013,the inner femoral cartilage to lateral tibial cartilage right t=5.208 P=0.000,left t=3.182 P=0.006,the medial femoral cartilage to the lateral tibial cartilage right t=4.942 P=0.000,left t=7.288 P=0.000,the medial femoral cartilage to the inner tibial cartilage right t=5.564 P=0.000,left t=4.369 P=0.001.Bilateral Comparison of Healthy volunteers Group:lateral femoral cartilage between bilateral knees t=1.048 P=0.302,the medial femoral t=2.410 P=0.021,inner femur t=0.932 P=0.358,the lateral tibial cartilages t=0.098,P=0.923,inner tibial cartilage thickness t=-0.785 P=0.438.The difference in thickness of cartilage between right lateral femur and left inner femur with paired-samples t-test was t=0.070 P=0.945.The difference in thickness of cartilage between right inner femur and left lateral femur with paired-samples t-test was t=2.410 P=0.021.The difference in thickness of cartilage between right lateral tibia and left inner tibia with paired-samples t-test was t=-1.330 P=0.192.The difference in thickness of cartilage between right inner tibia and left lateral femur with paired-samples t-test was t=0.624 P=0.536.Bilateral Comparison of Abnormal Group:lateral femoral cartilage between bilateral knees t=0.517 P=0.613,the medial femoral t=-2.596 P=0.020,inner femur t=1.391 P=0.184,the lateral tibial cartilages t=-1.084 P=0.295,inner tibial cartilage thickness t=-1.318 P=0.273.The difference in thickness of cartilage between right lateral femur and left inner femur with paired-samples t-test was t=0.747 P=0.467 The difference in thickness of cartilage between right inner femur and left lateral femur with paired-samples t-test was t=1.199 P=0.249.The difference in thickness of cartilage between right lateral tibia and left inner tibia with paired-samples t-test was t=-1.139 P=0.273.The difference in thickness of cartilage between right inner tibia and left lateral femur with paired-samples t-test was t=-1.126 P=0.278Intergroup Difference t-test Results:age t=-2.497 P=0.016,weight t=-1.440 P=0.156,height t=0.691 P=0.493,BMI t=-1.685 P=0.098.Cartilage thickness of right lateral femur between two group t=-1.069 P=0.290,rihgt inner femur t=-1.431 P=0.0159,medial femur t=1.295 P=0.201,right lateral tibial t=-1.220 P=0.228,right inner tibial t=-0.757 P=0.453.Left lateral femur t=-1.579,P=0.121,left inner femur t=-0.285 P=0.777,left medial femur t=-1.998 P=0.047,left lateral tibial t=-2.425 P=0.019,left inner tibial t=-1.409 P=0.206Correlation Analysis of Healthy volunteers Group:(1)Gender:With the cartilage thickness of lateral femoral surface:right r=0.031 P=0.856,left r=0.214 P=0.211,with medial femur:right r=0.194 P=0.258,left r=0.167 P=0.331,with inner femur:right r=0.088 P=0.610,left r=-0.102 P=0.554,with lateral tibial:right r=0.127 P=0.461,left r=0.184 P=0.282,with inner tibial:right r=0.320 P=0.057,left r=0.165 P=0.203.(2)Age:With the cartilage thickness of lateral femoral surface:right r=-0.039 P=0.820,left r=0.354 P=0.258,with medial femur:right r=-0.018 P=0.919,left r=-0.124 P=0.470,with inner femur:right r=-0.111 P=0.519,left r=-0.213 P=0.212,with lateral tibial:right r=-0.421 P=0.001,left r=-0.359 P=0.005,with inner tibial right r=-0.273 P=0.107,left r=-0.250 P=0.052.(3)Weight:With the cartilage thickness of lateral femoral surface:right r=-0.34 P=0.842,left r=-0.005 P=0.979,with medial femur:right r=-0.081 P=0.638,left r=0.122 P=0.479,with inner femur:right t=-0.220 P=0.197,left r=-0.038 P=0.826,with lateral tibial:right r=-0.078 P=0.650 left r=-0.011 P=0.949,with inner tibial:right r=-0.119 P=0.488 left r=-0.057 P=0.742.(4)Height:With the cartilage thickness of lateral femoral surface:right r=-0.34 P=0.842,left r=-0.117 P=0.370,with medial femur:right r=-0.045 P=0.733,left r=0.122 P=0.479,with inner femur:right r=-0.045 P=0.733,left r=0.180 P=0.293,with lateral tibial:right r=-0.188 P=0.272 left r=0.127 P=0.460,with inner tibial:right r=0.196 P=0.252 left r=0.167 P=0.331(5)BMI:With the cartilage thickness of lateral femoral surface:right r=-0.122 P=0.479,left r=-0.176 P=0.304,with medial femur:right r=-0.190 P=0.266,left r=0.021 P=0.903,with inner femur:right r=-0.283 P=0.094,left r=-0.063 P=0.716,with lateral tibial:right r=-0.004 P=0.983 left r=-0.029 P=0.867,with inner tibial:right r=-0.075 P=0.662 left r=-0.009 P=0.959.Correlation Analysis of Abnormal Group:(1)Gender;With the cartilage thickness of lateral femoral surface:right r=0.000 P=1.000,left r=0.085 P=0.211,with medial femur:right r=0.275 P=0.303,left r=0.128 P=0.636,with inner femur:right r=0.102 P=0.706,left r=-0.045 P=0.554,with lateral tibial:right r=0.217 P=0.419,left r=0.203 P=0.450,with inner tibial:right r=0.304 P=0.252,left r=0.288 P=0.279.(2)Age:With the cartilage thickness of lateral femoral surface:right r=-0.096 P=0.724 left r=-0.138 P=0.612,with medial femur:right r=-0.277 P=0.299 left r=-0.103 P=0.705,with inner femur:right r=0.088 P=0.610,left r=-0.099 P=0.716,with lateral tibial:right r=-0.050 P=0.854 left r=-0.133 P=0.622,with inner tibial:right r=-0.112 P=0.678 left r=0.070 P=0.797.(3)Weight:With the cartilage thickness of lateral femoral surface:right r=0.428 P=0.098 left r=0.225 P=0.401,with medial femur:right r=0.091 P=0.736 left r=0.167 P=0.537,with inner femur:right r=0.421 P=0.104 left r=0.146 P=0.588,with lateral tibial:right r=-0.002 P=0.996 left r=-0.073 P=0.789,with inner tibial:right r=-0.138 P=0.611 left r=-0.236 P=0.379.(4)Height:With the cartilage thickness of lateral femoral surface:right r=0.099 P=0.716,left r=0.108 P=0.691,with medial femur:right r=0.496 P=0.051,left r=0.183 P=0.497,with inner femur:right r=0.364 P=0.165,left r=-0.110 P=0.684,with lateral tibial:right r=0.098 P=0.719 left r=-0.249 P=0.352,with inner tibial:right r=0.037 P=0.892 left r=-0.096 P=0.723.(5)BMI:With the cartilage thickness of lateral femoral surface:right r=0.362 P=0.168 left r=0.083 P=0.760,with medial femur:right r=-0.268 P=0.316 left r=-0.026 P=0.923,with inner femur:right r=0.109 P=0.687 left r=0.207 P=0.442,with lateral tibial:right r=-0.089 P=0.742 left r=0.077 P=0.777,with inner tibial:right r=-0.154 P=0.569 r=-0.134 P=0.621.The cartilage ehcoes of the 64 voluteers in abnormal group did not evenly distributed.All of the cartilages could be found echo enhancement regions like cloud.The surfaces of the cartilages were not smooth.37 in 64 volunteers could be found the thickness of cartilage not regular,there were some sunken or hump on the cartilage surfaces.13 could be found hyper echo spots inside the cartilage.The surface of subchondral bone were coarse in 52 volunteers of the 64,37 of them had hyper echo local thickening on the subchondral surfaces.24 in the 64 volunteers had hyper echo spur on the surface of subchondral bone.And 25 could be found hyper echo spur on the capitulum margins,some of them had echo shadow.60 found synovial hyperplasia.13 had knee join hydrops.3 had popliteal cysts.6 could find short linear hyper echo in the subchondral bone.The ultrasound foud abnormal echo in all the 64 volunteers' cartilage or the surrounding tissues of abnormal group,52 in them were found obvious echo changes.But X ray found 33 having abnormal changes,such as spurs or higher density on the subchondral bones.The frequency of every part with severe cartilage changes in abnormal group and X2 test of bilateral knee:left inner femur 60,left lateral femur 25,intermedial femur 27,left inner tibia 7,left lateral tibia 6,right inner femur 39,right lateral femur 32,right intermedial femur 20,right inner tibia 18,right lateral tibia 18.X2 test of bilateral knee:X2=17.182 P=0.002Conclusion:The average thickness of noraml cartilages was during 0.18 cm to 0.26 cm.The average thickness of abnoraml cartilages was during 0.18 cm to 0.29 cm.The measuring results of pig knee cartilage thickness by ultrasound were very close to that measured by the vernier caliper.The ultrasound could describe exact conditions of knee articular cartilage.The distribution of cartilage thickness of healthy people are same on both side.It is thickest on the medial femur,thickness of inner femur similar to the lateral ones.The thickness of cartilage on the inner tibial was similar to the lateral tibia.The cartilage on the femur was thicker than the ones on the tibia.The medial femur cartilage was thicker than the left in healthy group.But the left was thicker than the right ones in the abnormal group.The distribution of cartilage thickness of abnormal group were not same on the two side.The cartilage thickness on the right femur were relatively uniform.And the cartilage thickness on the right tibia also even.But the femoral cartilage tickness still higher than the tibia ones.The medial femur cartilage was thickest on the left in abnormal group.The inner femur was similar to the lateral femur.It was also the same of two side of tibia.But differently,the inner femoral catilage thickness was similar to the inner tibia ones.The thickness of left medial femur cartilage,left lateral tibial cartilage,right inner femur ones in abnormal group were higher than the corresponding ones in normal group.And the average age of abnormal group was higher than the normal group.There was negative correlations between age and both side lateral tibial cartilage thickness in normal group.But the remaining parameters didn't have any correlation ralationship in either group.Ultrasonic manifestations of OA were mainly as follows:The echo of cartilage is not even.There was fine enhancement echo pots like cloud in the cartilage.The surface of cartilage is not smooth.Some could find hyper echo spot in parts of cartilage.If the condition was aggravated the thickness could be uneven,some sunken or bump could be found on the surface.The surface of subchondral bone will be coarse,and local thickening and enhancement will be found in locality.The spurs could be found on the subchondral bone surface under the cartilage or on the margin of the bone.Most of the abnomal volunteers had synovial hyperplasia.Some had joint hydrops,Subchondral cyst or popliteal cysts.The changes frequency of bilateral side was different,the inner femur was higher.The ultrasoud could take bigger advangtage on the OA diagnosis than X ray,especially on the early stage OA.Significance:This research got the normal ultrasonography of knee cartilage,the normal thickness of every part of the knee,and the cartilage thickness distribution of ipsilateral and bilateral knee.Used the ultrasound results of pig knee comparing to the results of Specimen measurements by vernier caliper to certify that the ultrasound could detect the knee cartilage accurately.Provided bases for ultrasound diagnosing OA.Sum up the manifestations of ultrasonograhy of abnormal group,Get the characteristic manifestation of OA.Make it is possible to diagnose OA in a earlier stage with ultrasound examination.Make sure that the age is a influnce factor in cartilage degeneration and the attake of OA.Make sure that the bilateral knee took different manifestation in OA,and the left knee have higher odds to be attack by OA,especially the inner femur.And the ultrasound could find more lesions about cartilage,espically the tiny changes,so it could play a more better role in the diagnosis of OA than the X ray.Because the ultrasound is timesaving,high performance in cost ratio,dynamic,observant,so it could be used to routine screening of OA.Espically in the hospitals there were not MRI beening equiped. |
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