基于能谱CT物质分离成像的膝骨关节炎中医证型的相关参数研究

膝骨关节炎（knee osteoarthritis，KOA）是影响中老年人生活质量的常见关节退行性疾病，属中医骨伤科优势病种之一［1-2］。患者就诊的主要原因是病情急性发作加重，疼痛剧烈，功能严重受限［3］。临床诊疗强调“三辨论治”，即辨证论治、辨病施治与辨位施法相结合［4］，但目前存在缺乏定量指标、疗效评价滞后等问题，制约辨证客观化及规范化［5］。可视化、定量化影像图像及参数可从解剖层面反映病理变化与证候的关系，可作为证候分类的参考指标，拓展望诊的深度和广度，有助于中医证型客观化［6-7］。因此，本研究回顾性收集发作期KOA住院患者118例，探讨不同中医证型KOA能谱CT成像脂基物质图的差异，为KOA的中医辨证分型寻找客观化依据。

1 资料与方法

1.1 一般资料

回顾性收集2019年1月至2021年12月陕西中医药大学附属医院收治的在诊疗前行双膝能谱CT

基于能谱CT物质分离成像的膝骨关节炎

中医证型的相关参数研究

翟冰莹1，贾永军2，康武林3，李晓伟1，姚洁1，刘芳1

1.陕西中医药大学护理学院，陕西咸阳712046；

2.陕西中医药大学附属医院医学影像科，陕西咸阳712000；

3.陕西中医药大学附属医院骨病科，陕西咸阳712000

［摘要］目的：探讨不同中医证型膝骨关节炎（KOA）能谱CT成像的髌下脂肪垫（IPFP）脂基物质含量、关节间隙面积和骨赘评级的差异。方法：回顾性分析发作期KOA患者118例，其中寒湿痹阻证51例（A组），气滞血瘀证40例（B组），肝肾亏虚证16例和气血虚弱证11例（C组），使用能谱CT检查后行基物质分离图像后处理及分析，探讨不同中医证型KOA能谱CT成像IPFP脂基物质含量、关节间隙面积及骨赘评级的差异。结果：各证型间脂肪/肌肉物质分离图像IPFP最大面积和CT值差异均无统计学意义（均P>0.05）。A组IPFP脂基物质含量最低，C组IPFP脂基物质含量最高（P<0.05），B组膝关节内侧间隙面积小（P<0.05）。各证型间膝关节外侧间隙面积和骨赘评级差异均无统计学意义（均P>0.05）。结论：IPFP脂基物质含量和关节间隙面积均与发作期KOA中医证型间存在一定相关性，能谱CT基物质分离成像在中医辨证施治KOA中具有一定的临床应用价值。

［关键词］骨性关节炎，膝；体层摄影术，X线计算机；中医证型；辨证分型

Correlation between TCM syndrome of knee osteoarthritis and energy spectrum CT material separation images

ZHAI Bingying1，JIA Yongjun2，KANG Wulin3，LI Xiaowei1，YAO Jie1，LIU Fang1

1School of Nursing，Shaanxi University of Chinese Medicine，Xianyang 712046，China；2Department of Medical Imaging，Affiliated Hospital of Shaanxi University of Chinese Medicine，Xianyang 712000，China；3Department of Orthopedics，Affiliated Hospital of Shaanxi University of Chinese Medicine，Xianyang 712000，China

［Abstract］Objective：To investigate the differences of the fat content in the infrapatellar fat pad （IPFP），the joint space area and osteophyte grading of knee osteoarthritis （KOA）in different TCM syndromes by energy spectrum CT. Methods：A total of 118 patients with acute painful KOA were retrospectively analyzed，among whom 51 case were cold-dampness stagnation syndrome （Group A），40 were qi stagnation and blood stasis syndrome （Group B），16 were liver-kidney deficiency syndrome and 11 were qi-blood deficiency syndrome （Group C）. All patients underwent energy spectrum CT，and the base material separation images were obtained and analyzed. The differences in the IPFP fat content，the joint space area and osteophyte grading in KOA patients with different TCM syndromes were compared. Results：There were no significant differences in the IPFP maximum area and CT value of the fat/muscle substance separation images among the three groups （both P>0.05）. Group A had the least IPFP fat content and Group C the most （P<0.05），Group B had the least medial joint space area （P< 0.05）. While there were no significant differences in the lateral joint space area and osteophyte grading among the three groups （both P>0.05）. Conclusion：There are certain correlations between the IPFP fat content，the joint space area and the TCM syndrome of acute painful KOA. The material separation images of energy spectrum CT has a clinical application value in TCM syndrome differentiation and treatment of KOA.

［Key words］Osteoarthritis，knee；Tomography，X-ray computed；Traditional Chinese medicine syndrome；Syndrome differentiation

DOI：10.3969/j.issn.1672-0512.2024.02.008

［基金项目］陕西省中医药管理局“骨退行性疾病中西医结合防

治“双链融合”中青年科研创新团队”（2022-SLRH-LJ-001）；陕西省科

技计划项目（2023-JC-YB-805）；陕西中医药大学优势特色与交叉学

科支持计划项目（2022XKZC05）。

［通信作者］刘芳，Email：*****************。