膝骨关节炎患者膝内翻畸形的影响因素分析

Analysis of factors influencing genu varum deformity in patients with knee osteoarthritis

目的:探讨膝骨关节炎(knee osteoarthritis,KOA)患者膝内翻畸形的影响因素。方法:纳入KOA患者237例,拍摄患者负重正位双下肢X线片,测量双下肢膝内翻角。两侧膝内翻角不一致时,记录角度较大者。从病历系统中提取患者的性别、年龄、文化程度、体质量指数、Kellgren-Lawrence影像分级、KOA家族史、膝关节外伤史、病程等信息。采用美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分标准评价患者膝关节运动功能,记录HSS膝关节评分;设计调查问卷获取患者工作姿势、工作类型、排便姿势、爬山频次、饮酒史、吸烟史、是否进行规律的伸展运动、通勤方式、住房类型、有无服用钙补充剂及水果、蔬菜、肉类摄入量等信息。根据膝内翻角大小将纳入的患者分为膝内翻角正常组(膝内翻角<10°)和膝内翻畸形组(膝内翻角≥10°)。先对2组患者的相关信息进行单因素对比分析,然后对其中组间差异有统计学意义的因素进行多因素Logistic回归分析。结果:问卷调查收回有效问卷232份,最终纳入KOA患者232例。膝内翻角正常组121例,膝内翻畸形组111例。2组患者性别、年龄、体质量指数、Kellgren-Lawrence影像分级、病程、HSS膝关节评分、工作姿势、工作类型、排便姿势、爬山频次、是否进行规律的伸展运动、通勤方式、住房类型、有无服用钙补充剂的比较,组间差异均有统计学意义(χ^(2)=5.033,P=0.025;t=-3.197,P=0.002;t=-4.487,P=0.000;χ^(2)=5.426,P=0.020;t=-6.454,P=0.000;t=3.715,P=0.000;χ^(2)=5.320,P=0.021;χ^(2)=5.772,P=0.016;χ^(2)=5.188,P=0.023;χ^(2)=4.566,P=0.033;χ^(2)=5.110,P=0.024;χ^(2)=6.718,P=0.035;χ^(2)=13.113,P=0.001;χ^(2)=5.994,P=0.014);2组患者文化程度、KOA家族史、膝关节外伤史、饮酒史、吸烟史、水果摄入量、蔬菜摄入量、肉类摄入量的比较,组间差异均无统计学意义(χ^(2)=0.114,P=0.736;χ^(2)=0.983,P=0.321;χ^(2)=2.958,P=0.085;χ^(2)=1.662,P=0.197;χ^(2)=0.145,P=0.703;χ^(2)=0.982,P=0.322;χ^(2)=1.359,P=0.244;χ^(2)=0.145,P=0.703)。Logistic回归分析结果显示,年龄、体质量指数、Kellgren-Lawrence影像分级、工作姿势、排便姿势、爬山频次、不进行规律的伸展运动、通勤方式(步行)、住房类型(无电梯且4楼及以上)均是KOA患者膝内翻畸形的危险因素(β=0.375,P=0.031,OR=1.455;β=0.428,P=0.010,OR=1.534;β=0.501,P=0.007,OR=1.650;β=0.481,P=0.008,OR=1.618;β=0.349,P=0.039,OR=1.418;β=0.382,P=0.048,OR=1.465;β=0.391,P=0.037,OR=1.478;β=0.406,P=0.013,OR=1.501;β=0.413,P=0.001,OR=1.511),HSS膝关节评分是KOA患者膝内翻畸形的保护因素(β=-0.513,P=0.005,OR=0.599)。结论:年龄、体质量指数、Kellgren-Lawrence影像分级、工作姿势、排便姿势、爬山频次、不进行规律的伸展运动、通勤方式(步行)、住房类型(无电梯且4楼及以上)均是KOA患者膝内翻畸形的危险因素,HSS膝关节评分是KOA患者膝内翻畸形的保护因素。

Objective:To investigate the factors influencing genu varum deformity in patients with knee osteoarthritis(KOA).Methods:Two hundred and thirty-seven KOA patients were enrolled in the study, and their weight-bearing anteroposterior X-ray films of lower limbs were taken for measuring the genu varum angles.The larger angle was recorded when the angles of genu varum were inconsistent between the 2 sides.The information about gender, age, education level, body mass index(BMI),Kellgren-Lawrence imaging classification, KOA family medical history, knee trauma history and disease course was extracted from the electronic medical record system.The knee motor function was evaluated by using the Hospital for Special Surgery(HSS)scoring criterion, and the HSS knee score was recorded.Moreover, a questionnaire was designed to obtain the patients’ information such as working posture, working type, defecation posture, mountain-climbing frequency, drinking history, smoking history, doing or not doing regular stretching exercise, commuting mode, housing type, taking or not taking calcium supplements,fruit,vegetable and meat.The patients were divided into normal genu varum angle group(genu varum angle of < 10 degrees)and genu varum deformity group(genu varum angle of ≥10 degrees).The single-factor comparative analysis was performed on the relevant information of patients in the 2 groups,followed by multi-factor logistic regression analysis on the factors with statistically significant differences between the 2 groups.Results:Two hundred and thirty-two valid questionnaires were collected,and 232 KOA patients were included in the final analysis,121 cases in normal genu varum angle group and 111 cases in genu varum deformity group.The information about gender,age,BMI,Kellgren-Lawrence imaging classification,disease course,HSS knee score,working posture,working type,defecation posture,mountain-climbing frequency,regular stretching exercise,commuting mode,housing type and taking calcium supplements was compared between the 2 groups,and the results revealed that the differences were statistically significant(χ~2=5.033,P=0.025;t=-3.197,P=0.002;t=-4.487,P=0.000;χ~2=5.426,P=0.020;t=-6.454,P=0.000;t=3.715,P=0.000;χ~2=5.320,P=0.021;χ~2=5.772,P=0.016;χ~2=5.188,P=0.023;χ~2=4.566,P=0.033;χ~2=5.110,P=0.024;χ~2=6.718,P=0.035;χ~2=13.113,P=0.001;χ~2=5.994,P=0.014),while there were no statistical differences in education level,KOA family medical history,knee trauma history,drinking history,smoking history as well as the intake of fruit,vegetable and meat between the 2 groups(χ~2=0.114,P=0.736;χ~2=0.983,P=0.321;χ~2=2.958,P=0.085;χ~2=1.662,P=0.197;χ~2=0.145,P=0.703;χ~2=0.982,P=0.322;χ~2=1.359,P=0.244;χ~2=0.145,P=0.703).The results of logistic regression analysis showed that the age,BMI,Kellgren-Lawrence imaging classification,working posture,defecation posture,mountain-climbing frequency,lack of regular stretching exercise,commuting mode(walking)and housing type(walk-up and the 4th floor or above)were the risk factors for genu varum deformity in KOA patients(β=0.375,P=0.031,OR=1.455;β=0.428,P=0.010,OR=1.534;β=0.501,P=0.007,OR=1.650;β=0.481,P=0.008,OR=1.618;β=0.349,P=0.039,OR=1.418;β=0.382,P=0.048,OR=1.465;β=0.391,P=0.037,OR=1.478;β=0.406,P=0.013,OR=1.501;β=0.413,P=0.001,OR=1.511),whereas the HSS knee score was the protective factor for genu varum deformity in KOA patients(β=-0.513,P=0.005,OR=0.599).Conclusion:The age,BMI,Kellgren-Lawrence imaging classification,working posture,defecation posture,mountain-climbing frequency,lack of regular stretching exercise,commuting mode(walking)and housing type(walk-up and the 4th floor or above)are the risk factors,whereas the HSS knee score is the protective factor for genu varum deformity in KOA patients.