双下肢不等长与原发性膝骨关节炎的关系及影像学特点的相关性研究  

Relationship of leg length discrepancy with knee osteoarthritis and its skeletal imaging characteristics

作　　者：闵红巍[1] 刘克敏[1] 亓攀 曲铁兵[1] Min Hongwei;Liu Kemin;Qi Pan;Qu Tiebing(School of Rehabilitation,Capital Medical University,Arthropathy Disagnosis and Treatment Center,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China)

机构地区：[1]首都医科大学康复医学院,中国康复研究中心北京博爱医院关节病诊疗中心,北京100068

出　　处：《中华解剖与临床杂志》2020年第5期466-471,共6页Chinese Journal of Anatomy and Clinics

基　　金：中国康复研究中心科研项目(2018ZX-36)。

摘　　要：目的探讨双下肢不等长(LLD)与原发性膝关节骨关节炎(KOA)发病的关系及影像学特点,为KOA的防治提供一定的理论依据。方法回顾性分析2017年6月—2019年8月北京博爱医院行人工膝关节置换术(TKA)的141例原发性KOA患者的临床及影像资料。其中男19例,女122例;年龄(67.8±9.4)岁;体质量指数(BMI)为(26.8±2.9)kg/m2。患者术前行双下肢全长CT检查,应用WebViewer软件测量双下肢骨骼长度、双侧解剖股骨胫骨角(AFTA)和骨盆倾斜角(PTA)。拍摄站立位膝关节正侧位X线片,评估KOA的严重程度(K-L分级)。根据双下肢骨骼长度差值将患者分为LLD组(差值>5 mm)和对照组(差值≤5 mm)。LLD组患者根据下肢的长度分为长腿侧和短腿侧。评估KOA患者LLD的发生率,比较LLD组和对照组性别、年龄、BMI及PTA值的差异。在LLD组中,采用Spearman相关性分析LLD大小与年龄、BMI和PTA的相关性。在LLD组,比较长腿侧与短腿侧AFTA、KOA K-L分级及已行TKA手术患者占比的差异。结果141例KOA患者中,LLD患者68例,LLD的发生率为48.2%。LLD组PTA(3.93°±3.13°)大于对照组(2.31°±2.06°),差异有统计学意义(t=3.654,P<0.05)。在LLD组,短腿侧AFTA(4.74°±7.02°)大于长腿侧(2.0°±5.69°),短腿侧行TKA者占89.7%(61/68),高于长腿侧的57.4%(39/68),差异均有统计学意义(χ^2=2.554、16.753,P值均<0.05),而短腿侧和长腿侧K-L分级之间差异无统计学意义(P>0.05)。在LLD组,Spearman相关分析结果显示,LLD大小与PTA呈正相关,差异有统计学意义(rs=0.547,P<0.01);而LLD大小与BMI、年龄之间无相关性,差异均无统计学意义(rs=0.082、0.075,P值均>0.05)。结论原发性KOA患者LLD发生率较高,KOA多发生在短腿侧,LLD会导致骨盆倾斜,LLD差异程度越大,畸形越严重。早期积极干预可能对预防KOA有一定的意义。Objective This work aims to explore the relationship between leg length discrepancy(LLD)and the onset and imaging features of primary knee osteoarthritis(KOA)to provide a theoretical basis for the prevention and treatment of this disease.Methods Clinical and imaging data of 141 patients with primary KOA who underwent total knee arthroplasty(TKA)were analyzed retrospectively from June 2017 to August 2019 in Beijing Bo'ai Hospital.Among these patients,19 were males and 122 were females with an average age of(67.8±9.4)years and body mass index(BMI)of(26.8±2.9)kg/m2.Prior to the operation,the whole legs were examined by CT,and bilateral leg length,anatomical femoral-tibial angle(AFTA),and pelvic tilt angle(PTA)were measured by Webviewer software.The K-L grade of KOA severity was evaluated using weight-bearing X-ray.The patients were categorized into LLD(LLD>5 mm)and control groups(LLD<5 mm)according to the magnitude of LLD.The LLD group was further divided into long and short leg sides according to lower limb length.The incidence of LLD in patients with KOA was evaluated,and the differences in sex,age,BMI,and PTA were compared between the two groups.In the LLD group,the association of LLD with age,BMI,and PTA was evaluated by Spearman correlation analysis,and the differences of AFTA,K-L grade,and TKA operation location(long or short leg side)were compared.Results Among the 141 patients with KOA,68 patients presented as LLD with incidence rate of 48.2%.The PTA(3.93°±3.13°)of LLD group was higher than that of control group(2.31°±2.06°),and the difference was statistically significant(t=3.654,P<0.05).In the LLD group,the AFTA of the short leg side(4.74°±7.02°)was larger than that of the long leg side(2.0°±5.69°),and the difference was statistically significant(χ^2=2.554,P<0.05).The operation rate of TKA in the short leg side was 89.7%(61/68),which was significantly higher than that in the long leg side at 57.4%(39/68),and the difference was statistically significant(χ^2=16.753,P<0.05).No statistically si

关 键 词：骨关节炎 膝 双下肢不等长 解剖股骨胫骨角 骨盆倾斜角 

分 类 号：R684.3[医药卫生—骨科学] R816.8[医药卫生—外科学]