影像学参数的变化与膝关节炎疼痛程度的探讨

Study on correlation between changes of imaging parameters and pain degree of knee osteoarthritis

目的探讨X线影像学参数的改变与膝骨关节炎(KOA)疼痛程度的相关性。方法选择广州市番禺区中医院2014年9月到2016年9月因KOA就诊患者90例,入选患者均拍摄膝关节轴位片,在影像归档和通信系统(PACS)上测量5个影像学指标,分别是髌股指数、髌股协调角(适合角)、外侧髌股角、髌股倾斜角、股骨滑车沟角;对KOA患者疼痛的程度进行模拟视觉疼痛评分(VAS),根据VAS评分结果分为VAS评分≥5分与VAS评分<5分两组,对两组的影像学指标进行比较;定义VAS评分1~3分为轻度疼痛,4~6分为中度疼痛,7~10分为重度疼痛,以VAS评分等级为因变量,各影像学参数为自变量进行logistic多元回归分析。结果两组间髌股指数差异有统计学意义(t=2.05,P<0.05),其他指标未见统计学差异;多元回归分析显示,髌股指数为中度疼痛的重要危险因素(比值比=1.345,P<0.05)。结论髌股指数与KOA患者疼痛程度有关,是引起中度疼痛的重要危险因素。髌股指数可作为评估KOA患者膝关节疼痛程度观察指标。

Objective To investigate the correlation between the changes of imaging parameters and the degree of pain in knee osteoarthritis(KOA).Methods Ninety patients with KOA were selected from September 2014 to September 2016 in Panyu District Hospital of traditional Chinese Medicine of Guangzhou.All the selected patients took knee joint axial X-ray films.Five imaging indicators were collected on picture archiving and communication systems(PACS)imaging system,namely patellofemoral index,patellofemoral coordination angle(suitable angle),lateral patellofemoral angle,patellofemoral tilt angle and femoral trochlear groove angle.The degree of pain in KOA patients was evaluated by visual analogue scale(VAS)pain score.According to the VAS score,the patients were divided into two groups:VAS score≥5 and VAS score<5.The imaging indicators of the two groups were compared.The correlation between VAS scores and imaging parameters were analyzed by logistic multiple regression analysis.Among them,1-3 was classified as mild pain,4-6 as moderate pain and 7-10 as severe pain.Results The patellofemoral index was significantly different between the two groups(t=2.05,P<0.05).There was no statistical difference in other indicators.Regression analysis showed that patellofemoral index and moderate pain had statistical significance(odds ratio=1.345,P<0.05).Conclusions There is a correlation between the change of lower limb force line and the degree of pain in KOA patients.Patellofemoral index is associated with moderate pain.