膝骨关节炎严重程度与脊柱-骨盆矢状面平衡的相关性

Correlation between Severity of Knee Osteoarthritis and Sagittal Balance of Spine and Pelvis

目的探讨原发性膝骨关节炎(knee osteoarthritis,KOA)影像学严重程度与脊柱-骨盆矢状面平衡之间的相关性。方法回顾性分析2015年1月至2016年5月在我院诊断为原发性KOA患者的膝关节及腰椎立位正侧位X线片。根据Kellgren-Lawrence(K-L)分级系统评估方法将其分为轻度、中度及重度KOA三组。若患者双侧膝关节均为KOA,则取严重的一侧进行分析。在腰椎侧位片上测量腰椎前凸角(lumbar lordosis angle,LL)、骨盆投射角(pelvic incidence,PI)、骨盆倾角(pelvic tilt,PT)及骶骨倾角(sacral slope,SS)。结果 148例原发性KOA患者纳入本研究,其中轻度KOA组33例、中度组80例,重度组35例。三组间年龄、性别及腰椎体退行性变严重程度差异均无统计学意义(P>0.05)。除PT外,LL、PI、SS与KOA影像学严重程度呈正相关,相关系数分别为0.361、0.349、0.289(P<0.001)。重度KOA组LL、PI及SS值均大于轻度组与中度组,差异有统计学意义(P<0.05),而轻度组与中度组间上述测量值差异无统计学意义(P>0.05)。结论重度KOA可影响脊柱-骨盆矢状面平衡。

Objective To investigate the correlation between the radiographic severity of primary knee osteoarthritis （KOA） and sagittal balance of spine and pelvis. Methods Retrospective analyzed the X-ray films of patients diagnosed with pri- mary KOA in the knee and lumbar lateral position from January 2015 to May 2016 in our hospital. According to the Kellgren-Law- renee classification system, the patients were divided into three groups ： mild, moderate and severe KOA. If the patient had KOA in bilateral knee joints, then the serious side was taken to analyze. We measured lumbar lordosis angle （LL）, pelvic incidence （PI）, pelvic tih（PT） ,sacral slope（SS）in the lumbar lateral radiograph. Results 148 cases of primary KOA patients were included in this study, mild KOA group had 33 cases, moderate group had 80 cases, severe group had 35 cases. There was no significant differ- ence between the three groups in age, gender and the degree of lumbar degenerative changes （ P 〉 0. 05 ）. Except for PT, LL, PI and SS were positively correlated with the severity of KOA imaging, and the correlation coefficients were 0. 361,0. 349, and 0. 289 （ P 〈 0. 001 ）. The LL, PI and SS values in the severe KOA group were higher than those in the mild group and the moderate group （P 〈0. 05 ）,but the measured value above had no significant difference between the mild group and the moderate group（ P 〉0. 05 ）. Con- clusion Severe KOA can affect the sagittal balance of spine pelvis.