| Purpose: To evaluate the diagnostic performance of high frequency knee ultrasound(US) to detect the severity of articular cartilage lesions using arthroscopic grading as the gold standard and to investigate the relationships between the CM syndrome of knee osteoarthritis and the feature of knee joint detected by high frequency ultrasound, providing the evidence for the diagnosis of knee osteoarthritis. Methods: 1. Diagnostic research: 70 knee osteoarthritic patients treated by knee arthroscopy were included in orthopaedic inpatient of first affiliated hospital of Gansu university of CM from March 2014 to September 2014. Before the arthroscopy, high frequency US of knee was performed to detect the degree of articular cartilage injuries, which was compared wth knee MRI and the golden standard-arthroscopic surgery, and then calculate the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of high frequency ultrasound in diagnosing the severity of distal femoral cartilage damage. 2. Cross-sectional survey study: 103 patients(112 knees) with symptomatic knee osteoarthritis were included at the same period. There were 21 males and 82 females at the age of 41 to 79 years old. To gather patients’ general information, CM syndromes of knee osteoarthritis(insufficiency of the liver and kidney, with stagnation of tendons and muscles; deficiency of the liver and kidney, with inter-obstruction of phlegm and stasis; insufficiency of the spleen and kidney, with dampness infusion into bone and joints) and the feature of high frequency knee ultrasound(including the height of effusion on patellar cystic, the thickness and blood flow of the synovial membrane, marginal osteophyte, the severity of articular cartilage injury, the numbers of popliteal fossa cyst), and statistically analysis of the differences and correlations on high frequency ultrasound findings among three kinds of CM syndromes. Results: 1. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of high frequency ultrasound in diagnosing the degree of distal femoral cartilage damage were 69.8%, 88.2%, 94.9%, 48.4% and 74.3%, respectively while those of MRI were 74.8%, 88.2%, 95.2%, 52.9% and 78.1% separately. The diagnostic efficiency of MRI in distal femoral cartilage damage is higher than US except on TG where US is the higher. 2. Compared with arthroscopy, Kappa coefficient of US on TG were 0.688(moderate to high consistency) and total k value is 0.454(moderate consistency), which represented moderate consistency. In contrast, Kappa coefficient of MRI on TG were 0.457(moderate consistency) and total k value is 0.514, which represented high consistency. 3.The difference was significant(P < 0.05) in the course of the disease among the three types of CM syndrome, with the type of deficiency of the liver and kidney with inter-obstruction of phlegm and stasis the longest, the type of insufficiency of the spleen and kidney with dampness infusion into bone and joints the middle, and the type of insufficiency of the liver and kidney with stagnation of tendons and muscles the shortest. The difference was significant(P < 0.05) on radiographic grading among the three types of CM syndrome. Grading 0 ~ Ⅱwere seen more in the type of insufficiency of the liver and kidney with stagnation of tendons and muscles, gradingⅠ~ Ⅲ were often seen in the type of insufficiency of the spleen and kidney with dampness infusion into bone and joints, and grading Ⅱ ~ Ⅳ the type of deficiency of the liver and kidney with inter-obstruction of phlegm and stasis. 4. There were statistically significant difference(P < 0.05) on the height of effusion on patellar cystic, the thickness of the synovial membrane among the three types of CM syndrome. The height of effusion on patellar cystic in the type of insufficiency of the spleen and kidney with dampness infusion into bone and joints was higher than that of the rest two types while the difference was not significant between the former. The thickness of the synovial membrane in the type of deficiency of the liver and kidney with inter-obstruction of phlegm and stasis was the largest, and that of the type of insufficiency of the spleen and kidney with dampness infusion into bone and joints the next, with that of the rest type the third. The difference was significant(P < 0.05) on blood flow grading of the synovial membrane among the three types of CM syndrome. The grading of blood flow on the synovial membrane in the type of insufficiency of the spleen and kidney with dampness infusion into bone and joints was the highest, and that of the type of deficiency of the liver and kidney with inter-obstruction of phlegm and stasis the next, and that of the rest type the third. Conclusions: 1. The sensitivity, specificity and accuracy of high frequency ultrasound in diagnosing the degree of distal femoral cartilage damage were 69.8%, 88.2% and 74.3%, respectively all of which were lower than those of MRI except on TG where US is the higher. The results of US was moderate consistent with that of arthroscopy.Positive ?nding in US is a strong indicator of arthroscopic degenerative changes of cartilage, but negative ?nding does not rule out articular cartilage injury. Ultrasound could be an effective method for the diagnosis of the severity of the femoral trochlear groove cartilage lesion. 2. A certain relevance was showed between CM syndrome types of Knee osteoarthritis and pathological feature under high frequency ultrasound. The height of effusion on patellar cystic in the type of insufficiency of the spleen and kidney with dampness infusion into bone and joints was highest, and the thickness of the synovial membrane and the grading of blood flow on the synovial membrane in the type of deficiency of the liver and kidney with inter-obstruction of phlegm and stasis was the largest. High frequency ultrasound provide a certain objective quantitative indicators for differentiate CM syndrome types of K nee osteoarthritis. |
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