膝关节骨关节炎患者膝关节内翻畸形与胫骨旋转角关系的临床研究

Clinical study on the relationship between knee deformity and tibial rotation in knee osteoarthritis patients

目的探讨膝关节骨性关节炎患者膝关节内翻畸形与胫骨旋转角的关系。方法随机选取80例(107膝)罹患膝关节炎内翻患者和50例(100膝)膝关节正常者,分为KOA组和对照组。测量胫股角(FTA)和胫骨旋转角(TTA),对比两组间胫股角和胫骨旋转角的差异及相关性。结果 KOA组FTA为(182.6±2.5)°,对照组FTA为(174.8±2.9)°,KOA组的FTA大于对照组(t=41.598,P<0.01);KOA组TTA为(20±8)°,对照组TTA为(25±8)°,KOA组的TTA小于对照组(t=6.360,P<0.01),对照组和KOA组男性[(174.3±2.2)°vs(181.9±2.2)°,t=24.319,P<0.01],女性[(175.0±2.4)°vs(184.8±3.3)°,t=17.490,P<0.01],40～59岁组[(173.1±2.0)°vs(177.0±2.2)°,t=63.808,P<0.01],60～69岁组[(174.7±2.0)°vs(179.2±2.2)°,t=76.181,P<0.01],>70岁组[(176.7±2.6)°vs(188.5±3.1)°,t=49.259,P<0.01],左侧[(175.3±2.2)°vs(183.9±3.3)°,t=29.871,P<0.01],右侧[(175.0±3.2)°vs(182.3±2.8)°,t=28.658,P<0.01]亚组间FTA差异有统计学意义;对照组和KOA组男性[(25±8)°vs(21±8)°,t=3.198,P<0.01],女性[(26±7)°vs(20±10)°,t=4.719,P<0.01],>70岁组[(23±10)°vs(18±8)°,t=6.651,P<0.01],左侧[(25±9)°vs(20±8)°,t=4.512,P<0.01],右侧[(25±9)°vs(21±8)°,t=2.973,P<0.01]亚组间TTA差异有统计学意义。KOA组40～59岁组(r=-0.317,P<0.05),60～69岁组(r=-0.429,P<0.05),>70岁组(r=-0.810,P<0.01),K-L分级Ⅱ级(r=-0.387,P<0.05),Ⅲ级(r=-0.442,P<0.05),Ⅳ级(r=-0.834,P<0.01)各亚组内胫股角和胫骨旋转角有相关性。结论 KOA患者膝关节内翻畸形与胫骨旋转角呈负相关,其相关程度受年龄和K-L分级的影响,KOA患者年龄越大,胫骨旋转角越小;K-L分级越高,胫骨旋转角越小。

Objective To explore the relationship between knee varus deformity and the rotation Angle of the tibia in patients with osteoarthritis of knee joint. Methods 80 patients with knee osteoarthritis and 50 normal people were randomly selected and divided into KOA group and control group. The difference and correlation of femorotibial angle(FTA) and tibial rotation angle(TTA) between the two groups were compared. Results In the KOA group, the FTA is(182.6 ± 2.5)°, the FTA in the control group is(174.8±2.9)°, FTA of the KOA group is bigger than the control group(t=41.598, P<0.01);and TTA of the KOA group is(20±8)°, the control group is(25±8)°, which is smaller than the control group(t=6.360, P<0.01). The FTA differences between the control group and the KOA group were statistically significant among males [(174.3±2.2)° vs(181.9±2.2)°, t=24.319, P<0.01], females [(175.0±2.4)° vs(184.8±3.3)°, t=17.490, P<0.01], 40-59 year [(173.1±2.0)° vs(177.0±2.2)°, t=63.808, P<0.01], 60-69 year [(174.7±2.0)° vs(179.2 ± 2.2)°, t=76.181, P<0.01],>70 year [(176.7 ± 2.6)° vs(188.5 ± 3.1)°, t=49.259, P<0.01], left side[(175.3±2.2)° vs(183.9±3.3)°, t=29.871, P<0.01] and right side [(175.0±3.2)° vs(182.3±2.8)°, t=28.658, P<0.01] subgroups. The TTA difference of male [(25±8)° vs(21±8)°, t=3.198, P<0.01], female [(26±7)° vs(20±10)°, t=4.719, P<0.01],>70 year group [(23±10)° vs(18±8)°, t=6.651, P<0.01], the left side [(25±9)° vs(20±8)°, t=4.512, P<0.01], the right side [(25±9)° vs(21±8)°, t=2.973, P<0.01] between control group and KOA group were statistically significant. In KOA group, FTA in 40-59 year group(r=-0.317, P<0.05), 60-69 year group(r=-0.429, P<0.05),>70 year group(r=-0.810, P<0.01), K-L classⅡ(r=-0.387, P<0.05),Ⅲ(r=-0.442, P<0.05),Ⅳ(r=-0.834, P<0.01) were all correlated with TTA. Conclusion The knee joint deformity of knee osteoarthritis was negatively correlated with the rotation angle of tibia, and its correlation was influenced by age and K-L classification.