成人大骨节病髌骨不稳的影响因素及其相关性分析

Factors influencing patellar instability in adults with Kaschin-Beck disease and their correlation

目的探讨成人大骨节病患者年龄、Kellgren-Lawrence分级(K-L分级)、Wiberg分型与髌骨稳定性之间的相关性。方法横断面调查甘肃省岷县店村镇柏柳村、折庄村、建村成人大骨节病例143例,每位患者均拍摄数字化X线摄影(DR)膝关节正侧位片、髌骨轴位片,依据DR X线片测量Insall指数、外侧髌股角、沟角、适合角、髌骨外移率、髌股指数等髌骨稳定性相关参数;同时根据髌骨Wiberg分型结果将患者分为4组,根据临床KBD分度将患者分为3组,并对组间髌骨形态学参数进行单因素及多因素方差分析;应用Spearman检验分析髌骨Wiberg分型、临床KBD分度、影像学K-L分级三者与髌骨稳定性的相关性。结果 (1)髌骨Wiberg分型单因素方差分析(ANOVA)结果显示,外侧髌股角随着髌骨分型级数的增加而减小,适合角、髌骨外移率、髌股指数随着髌骨分型级数的增加而增大,6个参数P均<0.05,即表示这种增加或减小的组间差异有统计学意义;KBD临床分度的ANOVA检验结果示,外侧髌股角随着临床分度增大而减小,而适合角、沟角、髌骨外移率、髌股指数随着临床分度增加而增大,除Insall指数P>0.05外,其余5个参数P均<0.05,即表示这种增加或减小的组间总体差异有统计学意义。(2)Spearman检验显示:Wiberg分型与外侧髌股角、适合角、髌骨外移率、髌股指数呈强相关(R=0.752、0.582、0.533、0.735,P<0.05);与年龄、K-L分级无相关性(R=0.024、0.030,P>0.05)。K-L分级与年龄呈强相关(R=0.782,P<0.05);与其它参数均无相关性(P>0.05)。年龄与K-L分级、外侧髌股角呈强相关(R=0.782,0.506,P<0.05);与Wiberg分型、Insall指数不相关(R=0.024、0.053,P>0.05);与适合角、髌骨外移率、髌股指数均呈中度相关(R=0.403、0.361、0.475,P<0.05)。结论髌骨Wiberg分型是影响髌骨稳定性的重要因素,年龄对髌骨稳定性也有一定影响;K-L分级不影响髌骨稳定性。

Objective To study the correlation of patellar stability with age,knee Kellgren Lawrence grading and patellar Wiberg typing of adults with Kaschin Beck disease(KBD).Methods Through cross sectional study,we asked143adult patients with KBD from several villages in Gansu Province to receive digital radiographic x ray(DR)which included lateral slice of knee joint and axis slice of patellar.Meanwhile,each patient had to undergo patellar stability measurement on the DR film which included some indexes such as Insall index,lateral patellofemoral angle,sulcus angle,congruence angle,lateral migrating ratio of patella,and patellofemoral index.Then,all the participants were divided into four groups based on the patella Wiberg typing and three groups based on KBD clinical grading.Last,we analyzed the correlation of patellar stability with patellar Wiberg typing,clinical KBD grading,and Kellgren Lawrence grading of the patients by Spearman test.Results①By ANOVA test on the patella Wiberg typing,lateral patellofemoral angle decreased with increased level of patella Wiberg typing,but congruence angle,lateral migrating ratio of patella,and patellofemoral index were increased with increased level of patella Wiberg typing.P values of the six indexes were all<0.05,which indicated that these differences between groups were significant.By ANOVA test on the KBD clinical grading,lateral patellofemoral angle decreased with increased level of KBD clinical grading,but congruence angle,lateral migrating ratio of patella,sulcus angle,and patellofemoral index increased with increased level of KBD clinical grading.Besides that P value of Insall index was>0.05,P value of the other five indexes were all<0.05,which indicated these differences between groups were significant.②Spearman test:a strong correlation lay between Wiberg patellar typing and other indexes including age,lateral patellofemoral angle,congruence angle,lateral migrating ratio of patella,and patellofemoral index(R=0.684,0.752,0.582,0.533,0.735,P<0.05).However,there was no correlation between Wiberg patellar typing and K-L photographical grading(R=0.030,P>0.05).K-L grading was strongly correlated with age(R=0.782,P<0.05),weakly correlated with lateral migrating ratio of patella(R=0.104,P>0.05),but not correlated with the others(R<0.1,P>0.05).Age was strongly correlated with K-L grading and lateral patellofemoral angle(R=0.782,0.506,P<0.05),moderately correlated with congruence angle,lateral migrating ratio of patella,and patellofemoral index(R=0.403,0.361,0.475,P<0.05),but not correlated with Wiberg typing,sulcus angle,or Insall index(R=0.024,0.074,0.053,P>0.05).Conclusion Patellar Wiberg typing is the key factor which influences latellar stability;age has a limited influence,while K-L grading does not affect patellar stability.