| Objective:To compare the differences of bone marrow perfusion among patients with knee osteoarthritis in different TCM syndromes,and to analyze the correlation between knee bone marrow perfusion,knee joint symptoms and signs in patients with knee osteoarthritis.Methods:The subjects were from unilateral knee osteoarthritis patients who were treated in the Orthopedics department,Shanghai Shuguang Hospital,from February 2018 to February 2019.According to TCM syndrome differentiation,they were divided into the syndrome of wind-cold-dampness arthralgia,the syndrome of liver and kidney deficiency and the syndrome of qi stagnation and blood stasis,20 cases in each group.All subjects underwent dynamic contrast-enhanced MRI scans to obtain horizontal-axis dynamic enhancement images.On the medial tibial plateau and the femur,four similar subchondral orbital regions of interest were extracted from the medial tibial plateau and the femur.The post-processing software was used to obtain the measurement contents:Ktrans,Kep,TTP,MAXConc,etc.Patients in three groups were compared with the blood flow parameters of the affected knees.The blood flow parameters of the affected side and the contralateral knees were compared among the three groups.Correlation analysis between the blood flow parameters of the affected knee and the WOMAC scores was performed in the three groups.Statistical analysis was performed using SPSS 17.0.The difference of the test level P<0.05 was statistically significant.Results: There was no significant difference among the sexes,age,BMI,and WOMAC scores among the three groups in terms of gender,age,BMI,and WOMAC scores(P>0.05).The three groups of patients constituted the same baseline.Three groups of patients were compared the perfusion parameters of Ktrans,Kep,TTP,and MAXConc with the medial tibial plateau and the medial femoral condyle of the affected knee.The medial tibial plateau of the lateral knee joints in the three groups of patients.The distribution of blood perfusion parameters of the medial femoral condyle was compared with the healthy side.The results were all P<0.05,and the difference was statistically significant.Combined with the average rank,it can be considered that the perfusion parameters of the medial tibial plateau and medial femoral condyle of the affected knee in the three groups were larger than those on the healthy side.Three groups of patients were compared the perfusion parameters of Ktrans,Kep,TTP,and MAXConc between the medial tibial plateau and the medial femoral condyle of the contralateral knee.After examination,the distribution of perfusion parameters of the medial tibial plateau and medial femoral condyle of the contralateral knee of the three groups were all P>0.05,the difference was not statistically significant,and the medial tibial plateau of the knee joints of the three groups of patients could be considered.The distribution of blood perfusion parameters of the medial femoral condyle was the same.Three groups of patients were compared Ktrans,Kep,TTP,and MAXConc between the medial tibial plateau and the medial femoral condyle of the affected knee.The distribution of perfusion parameters of the medial tibial plateau and medial femoral condyle of the affected group were all P<0.05,and the difference was statistically significant.It can be considered that the blood flow perfusion of the two parts of the affected knee joints in the three groups of patients.The parameter distributions are not all the same.There was no significant difference in Ktrans between the two groups of the affected side of the syndrome of wind-cold-dampness arthralgia group,the syndrome of qi stagnation and blood stasis group(P>0.15);the syndrome of wind-cold-dampness arthralgia group,the syndrome of liver and kidney deficiency group,the syndrome of qi stagnation and blood stasis group.There was a statistically significant difference in Ktrans between the two groups(P<0.15).Combined with the average rank,it can be considered that the Ktrans values of the two parts of the affected side of the syndrome of wind-cold-dampness arthralgia group and the syndrome of qi stagnation and blood stasis group are smaller than those of the syndrome of liver and kidney deficiency group,and the Ktrans values of the two parts of the affected part of the syndrome of wind-cold-dampness arthralgia group and the syndrome of qi stagnation and blood stasis group are the same.There was no significant difference in Kep among the lateral femoral condyle and the syndrome of qi stagnation and blood stasis group(P>0.15).There was a statistically significant difference in Kep between the medial platform of the syndrome of wind-cold-dampness arthralgia group and the syndrome of qi stagnation and blood stasis group.And there was a statistically significant difference in Kep between the medial tibial plateau and the medial femoral condyle of the affected knee of the syndrome of wind-cold-dampness arthralgia group,the syndrome of liver and kidney deficiency group and the syndrome of qi stagnation and blood stasis group,the syndrome of liver and kidney deficiency group(P<0.15).Combined with the average rank,it can be considered that the Kep value of the medialtibial plateau of the affected side of the syndrome of qi stagnation and blood stasis group is smaller than that of the syndrome of wind-cold-dampness arthralgia group;the Kep value of the two parts of the knee joints of the syndrome of wind-cold-dampness arthralgia group and the syndrome of qi stagnation and blood stasis group is smaller than that of the syndrome of liver and kidney deficiency group.The distribution of Kep values in the medial femoral condyle of the affected knee in the qi stagnation group and the syndrome of qi stagnation and blood stasis group were the same.There was no significant difference in the TTP value of the medial tibial plateau between the qi stagnation and blood stasis group(P>0.15).The syndrome of wind-cold-dampness arthralgia group,the syndrome of qi stagnation and blood stasis group had the knee joints femur.There was a statistically significant difference in the TTP between the medial femoral condyle of the affected knee of the syndrome of wind-cold-dampness arthralgia group,the syndrome of liver and kidney deficiency group and the syndrome of qi stagnation and blood stasis group,the syndrome of liver and kidney deficiency group(P<0.15).Combined with the average rank,it can be considered that the TTP value of the medial femoral condyle of the affected knee joints of the syndrome of qi stagnation and blood stasis group is smaller than that of the syndrome of wind-cold-dampness arthralgia group;the TTP value of the knee joints of the wind-cold-dampness group and the syndrome of qi stagnation and blood stasis group is smaller than that of the syndrome of liver and kidney deficiency group.The TTP values of the medial tibial plateau of the affected knee and the syndrome of qi stagnation and blood stasis group were the same.There were significant differences in the values of MAXConc between the two groups of the affected side of the syndrome of wind-cold-dampness arthralgia group and the syndrome of qi stagnation and blood stasis group;the syndrome of wind-cold-dampness arthralgia group and the syndrome of liver and kidney deficiency group;the syndrome of liver and kidney deficiency and the syndrome of qi stagnation and blood stasis(P< 0.15).Combined with the average rank,it can be considered that the value of MAXConc in the two parts of the affected side of the syndrome of wind-cold-dampness arthralgia group is smaller than that of the syndrome of qi stagnation and blood stasis group.Spearman correlation analysis was performed Ktrans,Kep,TTP,and MAXConc perfusion parameters and WOMAC scores between the medial tibial plateau and the medial femoral condyle of the affected knee.The P value of the syndrome of wind-cold-dampness arthralgia group was greater than 0.05.It can be considered that the blood perfusion parameters of the two parts of thesyndrome of wind-cold-dampness arthralgia group were not correlated with the WOMAC scores.There was a significant positive correlation between Ktrans and WOMAC scores in the medial tibial plateau of the syndrome of liver and kidney deficiency group(r=0.505 P=0.023).The remaining P values were all greater than 0.05.It can be considered that the medial femoral condyle Ktrans of the affected knee in the syndrome of liver and kidney deficiency group has no correlation with the WOMAC scores of the two sites Kep,TTP and MAXConc.There was a positive correlation between the medial tibial plateau Kep and the medial tibial plateau Kecon and WOMAC scores in the syndrome of qi stagnation and blood stasis group(r=0.505P=0.023;r=0.555 P=0.111).The remaining P values were greater than 0.05.It can be considered that there were no correlation between Ktrans,TTP,medial femoral condyles Kep,MAXConc and WOMAC scores in patients with qi stagnation and blood stasis.Conclusion: 1.Different patients with knee osteoarthritis of different TCM syndromes had different blood flow perfusion in the knee joints.The blood flow perfusion of the affected knee in the syndrome of liver and kidney deficiency group was higher than that in the syndrome of wind-cold-dampness arthralgia group and the syndrome of qi stagnation and blood stasis group.2.There was no correlation between blood perfusion parameters and WOMAC scores in the two groups of patients in the syndrome of wind-cold-dampness arthralgia group.There was a significant positive correlation between Ktrans and WOMAC scores in the medial tibial plateau of the syndrome of liver and kidney deficiency group.There was a positive correlation between the medial tibial plateau Kep and the medial tibial plateau MAXConc in the syndrome of qi stagnation and blood stasis group. |
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