CAJ | 학술논문

目的：通过对膝类风湿关节炎（RA）病人关节软骨、软骨下骨髓及半月板进行MR-病理对照分析，探讨膝RA的MRI特点及病变发生机制。方法收集我院2008年11月—2014年12月间确诊为膝RA并行全膝关节置换术的11例病人（共13只膝关节）资料。评价关节软骨、软骨下骨髓及半月板的MRI表现，并在显微镜下对观察膝RA病人膝关节各部位组织的病理学特点。当细胞成分不确定时，使用免疫组织化学方法确定细胞种类。对关节软骨损伤MRI分级和半月板损伤MRI分度以及不同部位关节软骨下骨髓水肿和关节软骨、半月板损伤的病理学表现分度进行分析，并采用Mann-Whitney U检验对位于裸区和远离裸区的软骨下骨髓水肿的病理学表现分度进行比较。结果本组膝RA病人中大部分病人的MRI关节软骨破坏程度为4级，半月板破坏程度为4度。 MRI显示52处软骨下骨髓水肿的部位中有18处（34.6%）于骨髓水肿上方覆盖有关节软骨且远离裸区，而34处（65.4%）的骨髓水肿位于裸区且邻近滑膜。在软骨下骨髓水肿的病理学表现中，纤维化、骨小梁镶嵌样结构及淋巴细胞浸润为最常见的表现。位于裸区和远离裸区骨髓水肿的两组间各种病理学表现分度差异均无统计学意义（均P＞0.05）。在关节软骨破坏的病理学表现中，纤维环、关节软骨破坏变薄及关节软骨增生为最常见的镜下病理表现。在全部13只切除的膝关节共26个半月板标本中，仅发现5个（19.2%）残留半月板标本，在MRI上均表现为萎缩、变薄，信号不均，其最常见的病理学表现为纤维化和吞噬包裹钙化碎片。结论晚期膝RA病人半月板及关节软骨破坏严重，骨髓水肿可发生于关节裸区或远离裸区部位，提示膝RA可同时累及多个部位，导致病人关节功能严重减退甚至丧失。
목적：통과대슬류풍습관절염（RA）병인관절연골、연골하골수급반월판진행MR-병리대조분석，탐토슬RA적MRI특점급병변발생궤제。방법수집아원2008년11월—2014년12월간학진위슬RA병행전슬관절치환술적11례병인（공13지슬관절）자료。평개관절연골、연골하골수급반월판적MRI표현，병재현미경하대관찰슬RA병인슬관절각부위조직적병이학특점。당세포성분불학정시，사용면역조직화학방법학정세포충류。대관절연골손상MRI분급화반월판손상MRI분도이급불동부위관절연골하골수수종화관절연골、반월판손상적병이학표현분도진행분석，병채용Mann-Whitney U검험대위우라구화원리라구적연골하골수수종적병이학표현분도진행비교。결과본조슬RA병인중대부분병인적MRI관절연골파배정도위4급，반월판파배정도위4도。 MRI현시52처연골하골수수종적부위중유18처（34.6%）우골수수종상방복개유관절연골차원리라구，이34처（65.4%）적골수수종위우라구차린근활막。재연골하골수수종적병이학표현중，섬유화、골소량양감양결구급림파세포침윤위최상견적표현。위우라구화원리라구골수수종적량조간각충병이학표현분도차이균무통계학의의（균P＞0.05）。재관절연골파배적병이학표현중，섬유배、관절연골파배변박급관절연골증생위최상견적경하병리표현。재전부13지절제적슬관절공26개반월판표본중，부발현5개（19.2%）잔류반월판표본，재MRI상균표현위위축、변박，신호불균，기최상견적병이학표현위섬유화화탄서포과개화쇄편。결론만기슬RA병인반월판급관절연골파배엄중，골수수종가발생우관절라구혹원리라구부위，제시슬RA가동시루급다개부위，도치병인관절공능엄중감퇴심지상실。
Objective By comparing the MRI findings of menisci, articular cartilage, and subchondral bone marrow of knee joints with pathological characteristic in patients with rheumatoid arthritis (RA), to explore the MR characteristics and underlying mechanisms in RA knee joints. Methods Between 2008 and 2014, 13 knee joints in 11 patients with RA, who had total knee arthroplasty, were included in the study, the degree of destructions of articular cartilage, bone marrow, menisci of knee joints were evaluated on MR images and pathological slices. When the pathologist was uncertain about the cell origin, the immunohistochemistry was done to identify the cell origin. We analyzed the degree of injury of articular cartilage and menisci,as well as the degree of injury of the pathological manifestations of subchondral bone, articular cartilage and menisci. We also compared the degree of pathological manifestations of the bone marrow edema under and distant from the bare area, using Mann-Whitney U test. Results The articular cartilage destruction were level 4 and menisci damage were level 4 on MRI in most patients. Totally 52 locations presented bone marrow edema on MRI, 18 of 52 (34.6%) sites of bone marrow edema were covered by cartilage and distant from bare area, while 34 of 52 (65.4%) sites located under the bare area.Fibrosis, mosaic structure, and lymphocytes infiltration were the most common changes in bone marrow with edema. There was no significant difference in severity of pathological findings between the edema areas under and distant from areas with damaged articular cartilage. For articular cartilage damage, fibrosis and thinning of the cartilage, and cartilage hyperplasia were the most common pathological changes. 5 of 26 (19.2%) menisci were found in resected samples, all the menisci showed atrophy, thinning, and heterogeneous intensityon MR. Fibrosis, engulfing calcified debris and fibrinoid necrosis were most commonly seen in menisci samples. Conclusion The menisci and articular cartilage are severely destroyed in patients with RA at late stage, bone marrow edema can be found at bare areas and areas distant from bare areas. RA in knee joints can involve several structures simultaneously, resulting in joint function decreased severely even disability.