目的:分析轻度与中重度疼痛股骨头坏死(Osteonecrosis of Femoral Head,ONFH)患者血清Ⅰ型胶原羧基端肽β交联肽(β-CTx)水平与骨髓水肿分级的差异,探讨疼痛与β-CTx水平及骨髓水肿的相关性.方法:自2022年1月至2023年6月,将符合纳入标准的99例股骨头坏死患者,根据入院时视觉模拟量表(VAS)评分高低分为两组.A组为轻度疼痛患者(VAS评分≤3分),47例;B组为中重度疼痛患者(VAS评分≥4分),52例.所有患者经保守治疗6个月后比较治疗前后患者血清β-CTx水平及骨髓水肿分级.结果:治疗前A组VAS评分为1.74±0.98,β-CTx水平为0.72±0.17;B组VAS评分为5.27±1.08,β-CTx水平为0.59±0.23.两组之间β-CTx水平差异有统计学意义(P＜0.05);Pearson相关分析表明,VAS评分与β-CTx水平呈低度正相关(r=0.269,P=0.007).治疗6个月后A组与B组患者VAS评分分别为1.47±0.90和3.87±1.52;β-CTx水平分别为0.38±0.18和0.42±0.23,治疗前后β-CTx水平差异有统计学意义(P＜0.05).骨髓水肿分级:治疗前A组1级18例,2级23例,3级6例;B组,1级7例,2级21例,3级24例.治疗后骨髓水肿分级:A组0级2例,1级33例,2级10例,3级2例;B组0级1例,1级16例,2级23例,3级12例.卡方检验结果表明,治疗前后患者疼痛程度与骨髓水肿分级有相关性,非参数检验表明各疼痛程度下骨髓水肿分级的平均秩次呈递增趋势.结论:股骨头坏死患者疼痛轻重与血清β-CTx水平及骨髓水肿分级呈正相关,中重度疼痛较轻度疼痛患者,其血清β-CTx水平及骨髓水肿分级均明显更高,提示坏死区域破骨细胞异常活跃所致的骨吸收及骨髓水肿所致的骨内高压可能是引起患者疼痛的重要因素.
Correlation Analysis of Pain Scores with Serum β-CTx and Bone Marrow Edema in Patients with Femoral Head Necrosis
Objective:To analyze the differences between serum collagen type Ⅰ carboxytel telopeptide β cross-linked pep-tide(β-CTx)and bone marrow edema grade in patients with mild to moderate to severe pain osteonecrosis of femoral head(ONFH),and to explore the correlation between pain and β-CTx and bone marrow edema.Methods:From January 2022 to June 2023,99 patients with ONFH who were admitted to our department and met the inclusion criteria were divided into two groups according to the VAS score at the time of admission.Group A consisted of 47 patients with mild pain(VAS scores≤3);in group B,52 patients with moderate to severe pain(VAS scores≥4)were present.After 6 months of conservative treatment,the serum β-CTx level and bone mar-row edema grade of all patients before and after treatment were compared.Results:The VAS scores of group A were 1.74±0.98 and β-CTx were 0.72±0.17 before treatment,while the VAS scores of group B were 5.27±1.08 and β-CTx were 0.59±0.23.There was a statistically significant difference in β-CTx between the two groups(P＜0.05).Pearson correlation analysis showed that VAS was positively correlated with β-CTx,r=0.269 and P=0.007.After half a year of treatment,the VAS scores of group A and group B were 1.47±0.90,3.87±1.52,and β-CTx were 0.38±0.18,0.42±0.23,re-spectively,and the difference between β-CTx before and after treatment was statistically significant(P＜0.05).Bone marrow ede-ma grade,group A before treatment,18 patients with grade 1,23 patients with grade 2,and 6 patients with grade 3;Group B,7 in Level 1,21 in Level 2 and 24 in Level 3.After treatment,there were 2 people in group A with grade 0,33 from grade 1,10 from grade 2,and 2 from grade 3.Group B has 1 person in Level 0,16 people in Level 1,23 people in Level 2,and 12 people in Level 3.The results of Chi-square test showed that there was a correlation between the pain level and the bone marrow edema grade before and after treatment,and the non-parametric test showed that the average rank of bone marrow edema grade under each pain degree showed an increasing trend.Conclusion:In patients with ONFH,the severity of pain is positively correlated with serumβi-CTx level and bone marrow edema grade.Patients with moderate to severe pain had significantly higher serum β-CTx levels and bone marrow edema grades,suggesting that bone resorption caused by abnormal activity of osteoclasts in the necrotic area and intraosseous hypertension caused by bone marrow edema may be important factors causing pain.
osteonecrosis of femoral headmagnetic resonance imaging(MRI)visual analogue scale(VAS)scoreβ-CTx
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