股四头肌肌肉内脂肪浸润与KOA患者临床严重程度和运动功能相关性研究

The Correlation between Intramuscular Fat Infiltration of the Quadriceps Femoris and Clinical Severity and Motor Function in KOA Patients

摘要: 目的：探究膝关节骨性关节炎(Knee osteo arthritis, KOA)患者单个股四头肌回声强度与临床严重程度的关系。方法：招募2023年10月至2024年05月在青岛大学附属医院就诊的55例单侧KOA患者，使用肌骨超声评估股四头肌(Quadriceps Femoris, QF)回声强度(Echo Intensity, EI)，EI包括直接测得EI及使用皮下脂肪校正后的EI。膝关节损伤和骨关节炎结果评分(Knee Injury and Osteoarthritis Outcome Score, KOOS)用于评估患者膝关节功能及症状。5次起坐试验、起立行走测试以及5米步行测试用于评估患者运动功能。采用相关分析及回归分析，以阐明股四头肌EI与KOA患者临床严重程度之间的关系。结果：与健侧相比，KOA患者患侧股四头肌四块肌肉的EI均明显增高(p < 0.05)。KOA患者股四头肌EI，尤其是股内侧肌(Vastus Medialis, VM)的EI，与患者运动功能以及KOOS症状、疼痛及日常生活能力呈显著相关。多元线性回归分析表明，VM校正后的EI与KOOS症状[B = −0.157; 95%CI, −0.247~−0.066; p = 0.001]、疼痛[B = −0.200; 95%CI, −0.349~−0.051; p = 0.009]、日常生活能力[B = −0.214; 95%CI, −0.327~−0.100; p < 0.001]、5CST [B = −0.028; 95%CI, 0.012~0.044; p = 0.001]和5MWT [B = 0.013; 95%CI, 0.001~0.025; p = 0.032]显著相关。RI校正后的EI与KOOS症状[B = −0.122; 95%CI, −0.229~−0.015; p = 0.026]和TUG [B = 0.019; 95%CI, 0.002~0.035; p = 0.029]显著相关。RF校正后的EI与5MWT [B = 0.017; 95%CI, 0.002~0.033; p = 0.029]显著相关。结论：KOA患者股四头肌，特别是股内侧肌回声强度增加，会导致膝关节疼痛、症状加重和日常功能障碍。

Abstract: Objective: To investigate the relationship between the echo intensity (EI) of the quadriceps femoris (QF) muscle and clinical severity in patients with knee osteoarthritis (KOA). Methods: Fifty-five unilateral KOA patients were recruited, and the EI of the QF muscle was assessed using musculoskeletal ultrasound, incorporating both the direct measurement of EI and the subcutaneous fat-corrected EI. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to evaluate knee joint function and symptoms, while the 5-times sit-to-stand test (5CST), timed up and go test (TUG), and 5-meter walk test (5MWT) were employed to assess motor function. Results: The EI of the affected quadriceps femoris in KOA patients was significantly higher than that of the unaffected side (p < 0.05). Specifically, the vastus medialis (VM) showed a strong correlation with motor function as well as with KOOS domains covering symptoms, pain, and activities of daily living (ADL). Multiple regression analysis revealed that the corrected EI of the VM was significantly associated with KOOS symptoms [B = −0.157; 95% CI, −0.247 to −0.066; p = 0.001], pain [B = −0.200; 95% CI, −0.349 to −0.051; p = 0.009], ADL [B = −0.214; 95% CI, −0.327 to −0.100; p < 0.001], 5CST [B = −0.028; 95% CI, 0.012 to 0.044; p = 0.001], and 5MWT [B = 0.013; 95% CI, 0.001 to 0.025; p = 0.032]. Furthermore, the corrected EI of the rectus intermedius (RI) was significantly associated with KOOS symptoms [B = −0.122; 95% CI, −0.229 to −0.015; p = 0.026] and TUG [B = 0.019; 95% CI, 0.002 to 0.035; p = 0.029]. Similarly, the corrected EI of the rectus femoris (RF) was significantly correlated with the 5MWT [B = 0.017; 95% CI, 0.002 to 0.033; p = 0.029]. Conclusion: In patients with knee osteoarthritis (KOA), increased echo intensity in the quadriceps femoris, particularly within the vastus medialis, is significantly associated with knee pain, symptom progression, and impairments in daily functional activities.