膝骨性关节炎下肢负重位等比例全长X线片测量与分析  

Measurements and analyses of full length weight bearing X-ray radiographs of bilateral lower extremities in patients with knee osteoarthritis

作　　者：武建运 左建林[1] 刘潼[1] 高忠礼[1] WU Jian-yun ZUO Jian-lin LIU Tong GAO Zhong-li(Department of Orthopaedics ,China Japan Union Hospital ,Jilin University, Changchun 130031 ,Jilin , China)

机构地区：[1]吉林大学中日联谊医院骨科,吉林长春130031

出　　处：《中国骨伤》2016年第9期791-794,共4页China Journal of Orthopaedics and Traumatology

基　　金：吉林省自然科学基金重点科技攻关项目(编号:20130206102SF)~~

摘　　要：目的 ：对膝骨性关节炎患者的下肢负重位等比例全长X线片进行测量与分析,明确该组人群下肢解剖和力学轴线的特征性变化。方法：收集自2015年6月至2016年5月膝骨性关节炎患者下肢负重位等比例全长X线片数据和具有血管病变而无膝关节病史患者下肢CTA扫描数据。将具有血管病变而无膝关节病史患者作为正常人组,共20例40膝,男7例,女13例,年龄24～72岁,平均63.2岁;将膝骨性关节炎患者作为关节炎组,并将关节炎组分为内翻膝组和外翻膝组,共53例100膝,男10例,女43例,年龄52～80岁,平均64.7岁。测量股骨角（F角）、胫骨角（T角）、关节间隙角（JS角）、股胫角（FT角）、髋-膝-踝角（HKA角）、膝生理外翻角（KPV角）及股骨头颈偏距（offset）。对测量数据进行统计分析。结果 ：正常人组F角（79.9±2.3）°,T角（93.8±3.7）°,JS角（1.7±1.0）°,FT角（175.4±4.0）°,HKA角（181.4±4.1）°,KPV角（6.0±1.0）°,offset（38.5±6.5）mm;骨关节炎组F角（81.4±3.5）°,T角（94.6±2.7）°,JS角（2.1±2.5）°,FT角（178.1±6.3）°,HKA角（184.3±6.9）°,KPV角（6.2±1.5）°,offset（38.1±9.2）mm。KPV角在内翻膝（6.5±1.4）°和外翻膝（5.5±1.5）°之间差异有统计学意义（t=2.956,P=0.005）;KPV角与患者年龄之间有相关性（r=0.241,P=0.016）;股骨偏心距与KPV角之间有相关性（r=0.946,P=0.000）。结论 ：膝骨性关节炎平均膝关节生理外翻角为6.2°,并且与年龄、股骨偏心距呈正相关。内翻膝的平均膝关节生理外翻角大于外翻膝约1°。膝骨性关节炎下肢力学参数的改变可能与膝骨性关节炎的发生和发展有关。在TKA术前对下肢全长等比例X线片进行测量评估,取得下肢力学数据作为参考,可使得术中截骨变得更加合理、个体化。Objective：To reveal the characteristics of anatomical and mechanical axes in lower extremities by analyzing full-length weight-bearing X-ray radiographsin patients with knee osteoarthritis（OA）.Methods：From June 2015 to May 2016,the lower extremity CTA was performed for 20 patients with vascular diseases,and these patients without OA were assigned to the normal group.There were 7 males and 13 females,ranging in age from 24 to 72 years old with an average age of 63.2 years old.The weight-bearing full-length X-ray radiographs of the lower extremities were taken for 53 patients with knee OA,and these patients were assigned to the OA group.There were 10 males and 43 females,ranging in age from 52 to 80 years old with an average age of 64.7 years old.The osteoarthritis group were divided into two groups：varus knee group and valgus knee group.The femoral shaft double condyle angle（F）,tibial shaft plateau angle（T） Joint gap angle（JS）,femoral tibial angle（FT）,hip-knee-ankle angle（HKA）,knee physiological valgus angle（KPV）,and femoral offset were measured.The SPSS 21.0was used to analyze the statistical data.Results：The mean F were（79.9±2.3）° and（81.4±3.5）°,T were（93.8±3.7）° and（94.6±2.7）°,JS were（1.7±1.0）° and（2.1±2.5）°,FT were（175.4±4.0）° and（178.1±6.3）°,HKA were（181.4±4.1）° and（184.3±6.9）°,KPV were（6.0±1.0）° and（6.2±1.5）°,offset were（38.5±6.5） mm and（38.1±9.2） mm in the normal and OA group respectively.There was a significant difference in the KPV between varus knee and valgus knee groups（t=2.956,P=0.005）,and the greater mean KPV was found in varus knee.Positive correlations were found between KPV and age（r=0.241,P=0.016）,as well as between KPV and offset（r=0.946,P=0.000）.Conclusion：The average KPV in patients with knee OA was 6.2° in the present study,and the KPVs were also positively correlated with the patients ＇ ages and the femoral offsets.The average KPV in the varus knee was greate

关 键 词：骨关节炎 膝 放射测量术 关节成形术 置换 膝 膝外翻 

分 类 号：R684.3[医药卫生—骨科学]