膝骨关节炎评分指数与冠状位生物力学的相关性研究

A Study on the Correlation Between Knee Osteoarthritis Score Index and Coronary Biomechanics

目的本研究通过分析膝骨关节炎(knee osteoarthritis,KOA)患者西安大略和麦克马斯特大学(the Western Ontario and McMaster universities,WOMAC)关节炎指数与冠状位下肢力线角度及腰椎生物力学因素的相关性,为临床诊治KOA提供新思路。方法选自2022年10月至2023年5月就诊于河北中医药大学第一附属医院骨伤三科门诊且符合入组标准的267例KOA患者,其中男49例,女218例;年龄50~83岁,平均(61.55±8.72)岁。拍摄腰椎联合双下肢全长正位负重位X线片,观察腰骶偏移方向,测量冠状位下肢力线角度:髋膝踝角(hip knee ankle,HKA)、机械轴偏移距离(mechanical axis deviation,MAD)、关节线相交角(joint line convergence angle,JLCA)以及腰椎生物力学因素:腰骶偏移距离(lumbosacral offset distance,LOD)、腰膝偏移距离(waist and knee offset distance,WKOD),并对受试者进行WOMAC评分及基线资料记录,分析其与冠状位力线角度及腰椎生物力学因素的相关性。结果腰骶偏移方向与KOA疼痛严重侧存在相关性(P<0.05,r=0.569),LOD、WKOD、HKA、MAD、JLCA、病程与WOMAC评分均存在相关性(P<0.05,r值分别为:0.585、0.579、-0.156、0.173、0.175、0.189)。结论KOA患者关节疼痛、功能受限与腰椎重心的偏移及下肢力线角度存在相关性,KOA患者关节僵硬程度与病程存在相关性,其腰椎冠状位重心偏移是诱发或加重KOA的危险因素之一。

Objective To analyzes the correlation between the Western Ontario and McMaster universities(WOMAC)arthritis index,coronary lower limb force line angle,and lumbar biomechanical factors in knee osteoarthritis(KOA)patients,providing new ideas for clinical diagnosis and treatment of KOA.Methods 267 KOA patients who visited the Department of Orthopedics and Traumatology at the First Affiliated Hospital of Hebei University of Chinese Medicine from October 2022 to May 2023 and met the inclusion criteria were selected.This group included 49 males and 218 females,aged 50~83 years,with an average age of(61.55±8.72)years old.X-rays of the lumbar spine combined with the full length of both lower limbs in a weight-bearing position were taken.The direction of lumbosacral deviation was observed,and the force line angle of the lower limbs in a coronal position was measured:hip-knee-ankle angle(HKA),mechanical axis deviation(MAD),joint line convergence angle(JLCA).Lumbar biomechanical factors were also measured:lumbosacral offset distance(LOD),waist-knee offset distance(WKOD).The WOMAC score and baseline data of the subjects were recorded to analyze their differences.The correlation between coronal force line angle and lumbar biomechanical factors was then evaluated.Results There is a correlation between the direction of lumbosacral deviation and the severity of KOA pain(P<0.05,r=0.569).Furthermore,there is a correlation between LOD,WKOD,HKA,MAD,JLCA,disease duration,and WOMAC score(P<0.05,r values are 0.585,0.579,-0.156,0.173,0.175,0.189,respectively).Conclusion There is a correlation between joint pain and functional limitation in KOA patients and the shift of the lumbar center of gravity and lower limb force line angle.The degree of joint stiffness in KOA patients is correlated with the duration of the disease,and the shift of the lumbar coronal center of gravity is one of the risk factors for inducing or exacerbating KOA.