膝骨关节炎中骨性力线改变的影像学及临床研究

Radiographic and Clinical Study of the Alignment in Knee with Osteoarthritis

目的分析膝骨关节炎中骨性力线的改变与影像学及患者临床表现的相关性。方法利用影像归档与收集系统收集2017年9月至2017年12月我院关节科拟行膝关节表面置换术患者的影像及临床资料,于负重位下肢全长片上测量膝关节内外侧间隙,利用数学模型计算除外软骨因素后下肢骨性髋膝踝角(hip knee ankle,HKA)。根据骨性HKA角将患者分为两组,回顾性对比分析两组患者间年龄、Kellgren-Lawrence(KL)分级、病程、髋膝踝角、身体质量指数(body mass index,BMI)等指标。结果收集患者资料共30例,36膝。骨性HKA角≤174.4°,患者平均年龄为64.33岁,患病时间平均为11.83年,BMI平均为27.22 kg/m^2,视觉模拟评分(visual analogue score,VAS)平均为81.67分。骨性HKA角>174.4°,患者平均年龄为59.33岁,患病时间平均为5.67年,BMI平均为27.84 kg/m^2。VAS评分平均为70.83分。两组患者年龄、患病时间、内外侧关节间隙、VAS评分比较差异有统计学意义(P<0.05),BMI、内外侧关节间隙差值、比值、胫骨平台横径比较差异无统计学意义(P>0.05)。骨性HKA角与患者年龄、患病时间、内侧关节间隙、外侧关节间隙、VAS评分明显相关(P<0.05);与关节间隙差值、胫骨平台横径、BMI相关性不明显(P>0.05)。结论膝骨关节炎中生物力学改变和不均匀沉降在疾病的发生发展过程中作为独立因素存在。膝关节不均匀沉降引起的骨性HKA角减少,是引起膝关节骨关节炎的一种重要因素,与关节软骨的退变、丢失共同引起和加重关节炎患者的临床症状。

Objective To compare and analyse the alignment changes in knee with osteoarthritis and its correlation with imaging and clinical Clinical manifestations. Methods The data of imaging and clinical manifestations of patients who underwent Total Knee Arthroplasty(TKA) were obtained with the help of Picture Archiving and Communication Systems(PACS).The joint space width and angles were measured using goniometers provided by PACS system with the help of a real protractor.Using the mathematical model to calculate the low limb’s bone hip-knee-ankle angle(HKA angle) which exclueded the cartilage factors.Patients were divided into two groups according to the bone-HKA angle.The age,Kellgren-Lawrence(KL) grade,course of disease,hip and knee ankle angle and BMI were retrospectively analyzed. Results A total of 30 patients(36 knee) were finally enrolled in the study.The mean age was 64.33,history of osteoarthritis was 11.83 years,BMI was 27.22 kg/m^2,and VAS score was 81.67 in patients with bone-HKA angle ≤174.4 degrees.The mean age was 59.33,history of osteoarthritis was 5.67 years,BMI was 27.84 kg/m^2,and VAS score was 70.83 in patients with bone-HKA angle >174.4 degrees.The of age,course of knee osteoarthritis and medial/lateral joint space width between two groups were statistically different,while there is no significance of the rest analytic items between the two groups.Bone-HKA angle was significantly correlated with age,the time of OA,and the medial and lateral joint space wide(P<0.05).The correlation of joint space wide difference,transverse diameter of tibial plateau with Bone-HKA was not obvious(P>0.05).Conclusion Biomechanical changes and non-uniform settlement existed as independent factors in the development and progression of knee osteoarthritis.The reduction of Bone-HKA angle caused by non-uniform settlement is a primary factor in OA.Articular cartilage degeneration and reduction of Bone-HKA aggravate the clinical symptoms of osteoarthritis patients.