腰椎退行性病变与原发性膝关节骨关节炎发病的关系

Primary study of relationship between lumbar degenerative disease and morbidity of primary knee osteoarthritis

目的初步研究腰椎退行性病变与原发性单膝骨关节炎发病率之间的关系。方法回顾分析2008年1至12月北京大学人民医院骨科115例原发性单膝骨关节炎和119例原发性双膝骨关节炎行人工全膝关节置换术的老年患者的临床资料，根据腰椎退变的体征和放射学改变将单膝、双膝患者分为上腰椎退变、下腰椎退变、全腰椎退变及无腰椎退变组，进行，检验，比较单、双膝患者的腰椎退变情况有无差异。结果原发性单膝骨关节炎患者腰椎间盘突出或神经根管狭窄侧与膝关节病变侧相同。单膝患者的腰椎退变发病率（60％）高于双膝骨关节炎患者的腰椎退变发病率（31．1％）,Х^2=19．723，P=0．000；单膝患者的上腰椎退变发病率（29．6％）高于双膝患者的上腰椎退变发病率（6．7％）,Х^2=20．720，P=0．000；单膝患者的下腰椎退变发病率（17．4％）高于双膝患者的下腰椎退变发病率（8．4％），Х^2=4．227，P=0．040；全腰椎退变发病率没有差异，Х^2=0．402，P=0．526。结论同一老年患者的原发性单膝骨关节炎发病与腰椎退变相关，特别是上腰椎退变会诱发单膝骨关节炎的发生和加重；原发性膝骨关节炎的屈曲畸形可能会导致下腰椎、甚至上腰椎退变的加重。

Objective To study the relationship between lumbar degenerative disease and morbidity of primary unilateral knee osteoarthritis. Methods The clinical data of 115 unilateral knee osteoarthritis patients and 119 bilateral knee osteoarthritis patients undergoing TKR （total knee replacement） at our hospital in 2008 were retrospectively analyzed. According to clinical signs of lumbar degenerative disease and radiological changes, these patients were divided into upper / lower / whole / none lumbar degenerative disease group respectively.Х^2 test was performed to compare the difference of lumbar degenerative conditions between unilateral knee osteoarthritis and bilateral knee osteoarthritis patients. Results The morbidity side of lumbar intervertebral disc protrusion or nerve root canal stenosis in primary unilateral osteoarthritis patients was the same as the morbidity side of primary unilateral osteoarthritis. Lumbar degenerative disease morbidity [ （34 ＋20 ＋ 15）/115 =60% ] of primary unilateral knee osteoarthritis was higher than that [ （3 ＋5 ＋4 ＋ 6 ＋ 19）/119 =31.1% ] of primary bilateral knee osteoarthritis （Х^2 = 19. 723, P = 0. 000） ; Upper lumbar degenerative disease morbidity （34/115 = 29. 6% ）of primary unilateral knee osteoarthritis was higher than that [ （ 3 ＋ 5 ）/119 = 6.7% ] of primary bilateral knee osteoarthritis, （Х^2 = 20. 720, P = 0. 000 ） ; lower lumbar degenerative disease morbidity （20/115 = 17.4% ）of primary unilateral knee osteoarthritis was higher than that [ （4 ＋ 6）/119 = 8.4% ] of primary bilateral knee osteoarthritis （Х^2 = 4. 227, P = 0. 040） ; there was no difference for whole lumbar degenerative disease morbidity between primary unilateral and bilateral knee osteoarthritis patients （Х^2 = 0. 402, P = 0. 526 ） . Conclusion The primary unilateral knee osteoarthritis morbidity is correlated with lumbar degenerative disease for the same elder patient. Upper lumbar degenerative disease can induce the incidence and aggravation of primary unilateral knee osteoarthritis ; the flexion deformity of primary knee osteoarthritis may cause the aggravation of lower lumbar degenerative disease, even upper lumbar degenerative disease.