女性单纯髌股关节炎严重程度的危险因素分析

Analysis of risk factors in severity of female patients with pure patellofemoral arthritis

目的探讨女性单纯髌股关节炎严重程度的相关危险因素。方法将上海长海医院骨科门诊及病房的100例女性单纯性髌股关节炎患者,根据Kellgren-Lawrence分级标准分为轻、中、重三组,比较分析三组患者年龄、体重指数(BMI)、文化程度、髌骨高度(Lt/Lp)、髌骨倾斜角、Q角、沟角的差别,并采用有序多分类Logistic回归分析方法探讨女性单纯髌股关节炎严重程度的相关危险因素。结果女性重度单纯髌股关节炎组的年龄(64.3±5.4)岁、BMI(26.4±1.3)kg/m^2、髌骨高度(1.35±0.16)、髌骨倾斜角(16.21±1.62)°、Q角(29.43±2.47)°,比中度髌股关节炎组的年龄(55.8±8.0)岁、BMI(25.3±1.3)kg/m^2、髌骨高度(1.25±0.14)、髌骨倾斜角(13.12±2.72)°、Q角(23.20±4.78)°大,中度髌股关节炎组比轻度髌股关节炎组的年龄(50.6±6.7)岁、BMI(24.3±1.6)kg/m^2、髌骨高度(1.19±0.13)、髌骨倾斜角(10.87±2.64)°、Q角(18.40±3.77)°大。女性单纯髌股关节炎的严重程度与Q角、年龄、BMI、髌骨倾斜角及髌骨高度相关(P<0.05),其中Q角为最强危险因素。结论 Q角、年龄、BMI、髌骨倾斜角及高位髌骨是女性单纯髌股关节炎严重程度的相关危险因素,其中Q角是女性单纯髌股关节炎严重程度的最重要的危险因素。对于早期存在Q角、髌骨倾斜角异常及高位髌骨异常的患者,特别是Q角有明显异常,且外侧髌股关节出现明显疼痛等不适症状时可考虑手术纠正,并适当控制体重,对于预防髌股关节炎的发生有重要意义。

Objective To discuss the risk factors which may be related to the degree of pure patellofemoral arthritis in female patients. Methods One hundred pure patellofemoral arthritis female patients were classified into three groups based on the Kellgren-Lawrence classification standard： minimal,moderate and serve groups. The differences of age,body mass index（ BMI）,level of education,patellar height,patellar tilt,Q angle,and sulcus angle were compared among the three groups,and ordinal Logistic regression was used to analyse the related risk factors of the degree of pure patellofemoral arthritis in the patients. Results All the values belonging to the most severe group [age（ 64. 3 ± 5. 4） years,BMI（ 26. 4 ±1. 3） kg/m2,patella height（ 1. 35 ±0. 16）,patella tilt angle（ 16. 21 ±1. 62） °,Q-angle（ 29. 43 ±2. 47） °] were the largest; the values of age（ 55. 8 ± 8. 0） years,BMI（ 25. 3 ± 1. 3） kg/m2,patella height（ 1. 25 ± 0. 14）,patella tilt angle（ 13. 12 ± 2. 72） °,Q-angle（ 23. 20 ± 4. 78） ° in the moderate group were the second; the values of age（ 50. 6 ± 6. 7） years,BMI（ 24. 3 ± 1. 6） kg/m2,patella height（ 1. 19 ± 0. 13）,patella tilt angle（ 10. 87 ± 2. 64） °,Q-angle（ 18. 40 ± 3. 77） ° in the minimal group were the smallest. The degree of patellofemoral arthritis was correlated with Q angle,age,BMI,patellar tilt and patellar height（ P〈0. 05）. Conclusions Q angle,age,BMI,patellar tilt and patellar height,are the risk factors related to the severity of pure patellofemoral arthritis in the patients of this study. In particular Q angle appears to play an important role. If these three factors of Q angle,patellar tilt or patellar height are abnormal in the female patients at an early age,especially with abnormal Q angle and obvious pain or discomfort of lateral patellofemoral,then an operation should be taken to correct these abnormities,also the body weight should be moderately controlled as this plays an important role in the prevention of patellofemoral arthritis.