短膝关节X线与下肢全长X线摄影评估骨性关节炎的比较研究  

Comparative study of short knee joint and lower limb full-length radiography in the evaluation of osteoarthritis

作　　者：隋琪瑞 王肖 李天然[2] SUI Qi-rui;WANG Xiao;LI Tian-ran(Jiamusi University School of Clinical Medicine,Heilongjiang 154007,China)

机构地区：[1]佳木斯大学临床医学院,黑龙江154007 [2]解放军总医院第四医学中心,北京100048

出　　处：《放射学实践》2024年第5期678-682,共5页Radiologic Practice

摘　　要：目的:评估行全膝关节置换术(TKA)的膝关节骨性关节炎(KOA)患者使用短膝关节X线与下肢全长X线进行冠状面对齐分析的一致性。方法:选取KOA患者100例(121侧膝关节)为研究对象,所有病例均进行站立位膝关节X线及双下肢全长X线检查,测量并分析解剖股骨远端外侧角(aLDFA)、解剖胫骨近端内侧角(aMPTA)、关节线夹角(JLCA),评估测量结果的相关性。测量股胫角(FTA)、髋膝踝角(HKA)并评估其相关性及膝关节对齐分类的一致性。结果:TKA术前,aLDFA、aMPTA、JLCA测量值在短膝关节X线与下肢全长X线之间有很好的相关性,ICC分别为0.844、0.895和0.858。术前FTA与术前HKA值相关系数极好(r=0.935,P<0.001);术后FTA与术后HKA值相关系数较好(r=0.741,P<0.001);此外,基于短膝关节X线与下肢全长X线评估冠状面对齐将导致不同的前后对齐,其中33.9%(41/121)患者的术后膝关节对齐分类不一致。结论:短膝关节X线与下肢全长X线的测量结果相关性较好,但对于术后冠状面下肢对齐的诊断错误率较高,短膝关节X线在评估TKA患者的冠状面对齐时不能完全替代下肢全长X线。Objective:To evaluate the consistency of coronal alignment analysis of short knee joint and lower limb full-length X-rays in patients undergoing total knee arthroplasty(TKA).Methods:100 patients with KOA(121 knees)were selected as the study subjects.All patients underwent short knee joint and lower limb full-length X-ray examination in the standing position.The anatomical distal lateral angle of the femur(aLDFA),anatomical proximal medial angle of the tibia(aMPTA),and joint line angle(JLCA)were measured and analyzed,and the correlation between the measured results was evaluated.The femoral,tibial angle(FTA),and hip-knee ankle angle(HKA)were measured and analyzed to assess their correlation and the consistency of knee alignment classification.Results:Before TKA,the measured values of aLDFA,aMPTA,and JLCA had a good correlation between the short knee joint and the full-length X-ray of the lower limb,with the ICC of 0.844,0.895,and 0.858,respectively.The correlation coefficient between preoperative FTA and preoperative HKA was excellent(r=0.935,P<0.001);The correlation coefficient between postoperative FTA and postoperative HKA was good(r=0.741,P<0.001).In addition,the assessment of coronal alignment based on the measurement of the short knee joint and the full-length of the lower limb will lead to different alignments classifications.Among them,33.9%(41/121)of patients have inconsistent classification of knee joint alignment after surgery.Conclusion:The measurement results of the short knee joint X-ray and the full-length X-ray of the lower limb have a good correlation.However,the diagnostic error rate of the lower limb alignment on the coronal plane after surgery is high.The short knee joint X-ray can only partially replace the lower limb full-length X-ray in evaluating the coronal alignment of TKA patients.

关 键 词：全膝关节置换术 骨性关节炎 膝关节X线 下肢全长X线 冠状面对齐 

分 类 号：R684.3[医药卫生—骨科学] R814.41[医药卫生—外科学]