成人大骨节病髌骨稳定性与Lysholm膝关节功能评分的多重回归分析

Correlation between patellar stability and keen Lysholm scoring in adult with Kaschin-Beck disease： a multiple linear regression analysis

目的探讨成人大骨节病患者髌骨稳定性与膝关节临床特征的相关性。方法2016年9月，采用一次性横断面调查方法，对甘肃省岷县店村镇柏柳村、折庄村、建村143例成人大骨节病患者进行调查．患者拍摄数字化X线摄影（digital radiography，DR）膝关节正、侧位片，髌骨轴位片。测量X线片中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，同时进行Lysholm膝关节功能评分，应用多重线性回归建立回归方程分析两者相关性。结果143名大骨节病患者的Insall指数、外侧髌股角、沟角、适合角、髌骨外移率、髌股指数分别为1．10±0．17、（14．49±1．47）。、（138．08±3．86）°、（11．55±2．17°、（1．34±0．13）％、1．18±0．10，Lysholm评分为（62．96±6．11）分。采用多重线性回归逐步法分析，Insall指数（X1）、适合角（x4）、髌骨外移率（X5）、髌股指数（X6）进入方程，剔除了外侧髌股角、沟角，建立多重线性逐步回归方程：Y=17．529＋15．232X5＋0．950X4＋15．957X6-4．224X1，调整后决定系数（砰）=0．559。入选的各变量对Lysholm分值的影响从大到小依次为适合角、髌骨外移率、髌骨指数、Insall指数，其中Lysholm评分与Insall指数呈负相关。经方差分析，F=46．642，P〈0．05，拟合的回归方程有统计学意义。结论成人大骨节病髌骨稳定性与膝关节Lysholm临床评分有相关件．其相关件从大到小依次为髋股指数、髌骨外移率、话合角和lnsall指数．

Objective To study the correlation between patellar stability and keen clinical manifestation in adults with Kaschin-Beck disease （KBD）. Methods Through a cross-sectional study in September 2016, one hundred and forty-three adult patients with KBD were asked to accept a digital radiographic X-ray （DR） which included positive and lateral slices of knee joint and axis slice of patellar. Meanwhile, every patient must undergo a Lysholm function evaluation for knee joint and morphological measurement on the DR film which included Insall index, lateral patellofemoral angle, sulcns angle, congruence angle, lateral migrating ratio of patella, and patellofemoral index. Then, the regression equation was built and the correlation analysis was made with multiple linear regression test. Results One hundred and forty-three patients＂ average scores of Insall index, lateral patellofemoral angle, sulcus angle, congruence angle, lateral migrating ratio of patella, patellofemoral index and Lysholm score were 1.10±0.17, （14.49±1.47）°, （138.08±3.86）°, （11.55±2.17）°, （1.34±0.13）%, 1.18±0.10, and （62.96±6.11） scores. By muhiple linear regression test, Insall index （X1）, congruence angle （X4）, lateral migrating ratio of patella （Xs）, and patellofemoral index （X6） were selected to enter into the equation; while, lateral patellofemoral angle and sulcus angle were rejected. The multiple linear regression equation was as follows： Y = 17.529 ＋ 15.232X5 ＋ 0.950X4 ＋ 15.957X6 - 4.224X1. The adjusted determination coefficient （R2） of the equation was 0.559. Those indexes which were selected to enter into the equation were ranked from big to small based on the impact on Lysholm as follow： congruence angle, lateral migrating ratio of patella, patellofemoral index, and Insall index. Among them, Lysholm score had a negative correlation with Insall index. Through variance analysis, F valve was 46.642, and P 〈 0.05, which meant the fitted equation had statistical significance. Conclusion There is significant correlation between the patellar stability and knee Lysholm scoring in adult with KBD, which is reflected with the following parameters from big to small in turn： patellofemoral index, lateral migrating ratio of patella, congruence angle and Insall index.