成人大骨节病治疗中膝关节形态的X线测量

X-ray measurement on adult knee joint from patients with KBD during treatment

目的通过对大骨节病(Kaschin Beck disease,KBD)患者膝关节中髌骨及髌股关节形态学参数的X线观测,探寻KBD的膝关节形态变化规律,为临床诊疗提供参数资料,为关节置换提供参数支持。方法对84例KBD住院患者的膝关节的X线片及相关的临床资料进行了回顾性分析。在X线片上进行了Kellgren-Lawrence及髌骨分型,测量了Insall指数、外侧髌股角、沟角、适合角、髌骨外移率、髌股指数等形态学参数与症状、疗效之间相关性。结果参数严重性越高,KBD临床表现越重,临床疗效越差,KBD临床症状越重,效果越差。结论膝关节X线参数可以作为KBD治疗效果和预后判断的重要参数。

Objective The morphologic parameters of the patella and patellofemoral joint from patients with Kaschin Beck disease （KBD） were observed and measured using X-ray to search the pattern of radiographic changes of KBD, and to provide data for the clinical diagnosis and treatment, and for the joint replacement. Methods Eighty-four inpatients with KBD were taken X-ray pictures and comprehensive treatment （such as hot wax, massage therapy, acupuncture with electric stimulation, traditional Chinese medicine and kinetotherapy）. The knee joint K-L grading, patella, patellar bone type shift rate, Insall index, sulcus angle, congruence angle, lateral patellofemoral angle, patellofemoral indices were measured on the pictures, and the clinical data about age, gender, clinical manifestations, clinical curative effect from inpatients with KBD were collected, and the correlation between clinical data and the morphologic parameters were anal- ysed statistically. Results Preliminary results indicate that the patients with KBD in higher level of K-L classification showed more severe the clinical symptoms, and got less the curative effect; the patients with greater congruence angle and the patellofemoral indices, revealed more severe clinical manifestations and gained less clinical effect; the patients with smaller lnsall index and lateral patellofemoral angle demonstrated more severe the clinical symptoms and obtained less curative effect. The patients with higher grades in classification of K-L and the patellar, and with greater patellofemoral exponent received higher WOMAC score, i.g more easier left worse sequelae with them after treatment. Conclusion The knee joint K-L grading, patellar type, Insall index, congruence angle, lateral patellofemoral angle, patellofemoral indices can be used as referent data for judging the clinical curative effect and prognosis of KBD.