膝骨关节炎患者前交叉韧带功能影像学影响因素分析  

X-ray imaging analysis of anterior cruciate ligament function in patients with knee osteoarthritis

作　　者：高广涵 张耀南[2] 石磊[2] 王林[2] 王飞[2] 郑子天 王鸿禹 郭民政 薛庆云[2] Gao Guanghan;Zhang Yaonan;Shi Lei;Wang Lin;Wang Fei;Zheng Zitian;Wang Hongyu;Guo Min-zheng;Xue Qingyun(Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chi-nese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Beijing Hospi-tal,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院/国家老年医学中心/北京协和医学院/中国医学科学院,100730 [2]北京医院/国家老年医学中心/中国医学科学院,100730

出　　处：《中华老年骨科与康复电子杂志》2024年第5期301-307,共7页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：中央高水平医院临床科研业务费。

摘　　要：目的探究在膝骨关节炎患者中,通过膝关节正、侧位X线片中的影像学信息判断前交叉韧带功能的方法。方法回顾性选取2021年10月至2023年12月,因膝骨关节炎入院治疗的患者156例,通过在手术中验证患者前交叉韧带功能并将其分为前交叉韧带有功能组和失功能组,对比两组患者在膝关节侧位片中胫骨平台磨损深度及最深位置、胫骨平台前后1/3位置磨损深度和正侧位片中膝关节骨赘分布情况,采用二元Logistic回归分析影像学变量对前交叉韧带功能判断的影响。结果共156例患者纳入本研究,男性59例(37.8%),女性97例(62.2%)。根据术中验证156例膝骨关节炎患者前交叉韧带功能结果,分为有功能组85例(54.5%),失功能组71例(45.5%)。有功能组磨损最深位置位于后方的占比为30.6%,失功能组磨损最深位置位于后方的占比为71.8%;有功能组D=1.7(1.3,2.1)mm,d1=1.2(0.8,1.6)mm,d2=0.8(0.5,1.1)mm,失功能组D=2.3(1.8,2.8)mm,d1=1.5(1.1,2.1)mm,d2=1.8(1.0,2.3)mm;有功能组胫骨平台及髁间有骨赘的占比分别为45.9%和38.8%,失功能组相应占比分别为73.2%和83.1%。有功能组K-L分级为Ⅳ级的占比为30.6%,失功能组K-L分级为Ⅳ级的占比为62.0%。磨损最深位置位于胫骨平台前方以及髁间没有骨赘是判断前交叉韧带功能的保护因素,而胫骨平台后1/3处磨损深度则为影响前交叉韧带功能的危险因素。结论前交叉韧带失功能的患者在膝关节侧位X线上表现为内侧胫骨平台磨损加重,且以后方磨损为著,并多伴有胫骨平台骨赘的增生,正位片多见髁间骨赘的增生。胫骨平台磨损最深位置、后1/3处磨损情况以及髁间骨赘增生情况可帮助医生准确判断ACL功能。Objective To evaluate the function of anterior cruciate ligament(ACL)more accurately in patients with knee osteoarthritis through the imaging information of anteroposterior and lateral knee X-ray.Methods 156 patients admitted to hospital with knee osteoarthritis from October 2021 to December 2023 were retrospectively selected.ACL function was verified during surgery and the patients were divided into functional and non-functional ACL groups.The wear depth and deepest position of the tibial plateau,the wear depth of anterior and posterior the tibial plateau in 1/3 position,and the distribution of knee osteophytic features in the anteroposterior and lateral knee X-ray of the two groups were compared,and the influence of imaging variables on the judgment of ACL function was analyzed by binary Logistic regression.Results A total of 156 patients were included in this study,with 59 males(37.8%)and 97 females(62.2%).According to the results of ACL function verification in 156 patients with knee osteoarthritis,they were divided into functional group(85 cases)and non-functional group(71 cases).In the functional group,the deepest wear position in the posterior was 30.6%,and in the non-functional group,the deepest wear position in the posterior was 71.8%.D=1.7(1.3,2.1)mm,d1=1.2(0.8,1.6)mm and d2=0.8(0.5,1.1)mm in functional group,D=2.3(1.8,2.8)mm,d1=1.5(1.1,2.1)mm and d2=1.8(1.0,2.3)mm in non-functional group;The proportions of osteo-phytes in tibial plateau and intercondylar fossa were 45.9%and 38.8%in functional group,73.2%and 83.1%in non-functional group,respectively.The proportion of the functional group with K-L gradeⅣwas 30.6%,and the proportion of the non-functional group with K-L gradeⅣwas 62.0%The deepest wear in front of the tibial plateau and the absence of osteophyte between the condyles are protective factors for judging ACL function,while the wear depth in the posterior 1/3 of the tibial plateau is a risk factor for affecting ACL func-tion.Conclusion The patients with ACL dysfunction showed increased wear

关 键 词：膝骨关节炎 前交叉韧带 X线 

分 类 号：R687.3[医药卫生—骨科学]