膝骨关节炎疼痛与髌骨关节紊乱影像学量化指标的关系

Correlation of imaging indexes of patellar axial disorder with pain of knee osteoarthritis

背景:膝骨关节炎所引起的患者疼痛在影像学上有所体现,髌骨轴位片影像学参数改变能为膝骨关节炎的临床疼痛症状做出合理评价。目的:探讨髌骨轴位片影像学参数改变与膝骨关节炎患者疼痛部位的相关性,为临床诊治膝骨关节炎提供参考。方法:选择2014年9月至2016年9月在广州中医药大学第一附属医院进行髌骨轴位片拍摄并符合研究纳入标准的膝骨关节炎患者共80例作为疼痛组,另选择健康志愿者30例作为健康组。2组均屈膝30°行髌骨轴位片拍摄,在PACS影像学图片计算机处理系统分别采集髌股指数、髌股协调角、外侧髌股角、髌股倾斜角、股骨滑车沟角5个影像学参数;将膝骨关节炎患者疼痛部位分为膝前区、膝后区、膝内侧和膝外侧4个区域。结果与结论:(1)疼痛组患者的髌股指数、髌股协调角以及外侧髌股角均大于健康组,差异均有显著性意义(P <0.05);2组髌股倾斜角以及股骨滑车沟角比较,差异无显著性意义(P> 0.05);(2)二元Logistic回归分析中,膝骨关节炎疼痛和外侧髌股角存在相关性(P=0.01);(3)OneWay-ANOVALSD统计分析中,疼痛组患者髌股倾斜角在膝前区和膝后区差异有显著性意义(P=0.038),其他影像学参数与不同疼痛部位的两两比较分析差异无显著性意义(P均> 0.05);(4)结果表明,与健康志愿者相比,膝骨关节炎疼痛患者存在髌股关节的紊乱,髌骨偏向外侧倾斜和偏移;外侧髌股角是导致膝骨关节炎疼痛的最主要因素,髌股倾斜角影响着膝前区和膝后区的疼痛。

BACKGROUND:Pain caused by knee osteoarthritis is reflected in imaging.Change of radiographic parameters of the tibial axis slice can provide a reasonable assessment for the clinical pain symptoms of knee osteoarthritis.OBJECTIVE:To analyze the correlation between the change of the imaging indexes of patellar axial radiograph and pain area in the knee osteoarthritis,thus providing reference for the diagnosis and treatment of knee osteoarthritis.METHODS:Available samples were collected from the First Affiliated Hospital of Guangzhou University of Chinese Medicine between September 2014 and September 2016,where totally 80 knee osteoarthritis patients were selected as pain group and 30 healthy volunteers were selected as control group.All the participants took patellar axial radiograph with knee at 30°through PACS imaging systems to collect five imaging indexes,including patella exponent,femur trochlea angle,congruence angle,lateral patellofemoral angle and tilt angle.Knee osteoarthritis patients in the pain group were divided into four common clinical pain areas which were anterior,posterior,medial and lateral area.RESULTS AND CONCLUSION:(1)The patellofemoral pain index,congruence angle,and lateral patellofemoral angle in the pain group were significantly larger than those in the control group(P<0.05).In the patellofemoral angle,patellofemoral subluxation and femoral trochlear angle parameters,there was no significant difference between two groups(P>0.05).(2)Two logistic regression analysis showed that there was a correlation between knee osteoarthritis pain and lateral patellofemoral angle(P=0.01).(3)From one way-ANOVA LSD statistical analysis,the patellofemoral angle in patellofemoral anterior and posterior areas had significant difference(P=0.038),and there were no differences in the other imaging parameters between pain areas(P>0.05).(4)In summary,compared with the health volunteers,in the patients with pain caused by knee osteoarthritis,patellofemoral joint disorder and patella angle affects the pain of anterior and posterior areas,which has a connection with the saphenous nerve,the branches of the sciatic nerve and peroneal nerve branch of conduction.