膝骨关节炎不同中医证型在X线表现上的 差异性研究

目的:探讨膝骨关节炎中医证型与X线表现的相关性,为临床诊疗提供依据。方法:2007年6-12月,收集骨科门诊78例(108膝)膝骨关节炎患者,男13例(19膝),女65例(89膝);年龄41～77岁。中医辨证分型:一型,肝肾不足、筋脉瘀滞证,43膝;二型,脾肾两虚、湿注骨节证,26膝;三型,肝肾亏虚、痰瘀交阻证,39膝。摄负重站立位膝关节正侧位、髌股关节Skyline位X线片,分别观察评价关节间隙狭窄、骨赘生成、软骨下骨硬化、软骨下囊变,测量下肢力线角,并进行K-L分级。用多个独立样本非参数检验分析3种证型与各种X线表现之间相关性。结果:3种证型在外侧髌骨骨赘、胫骨髁间骨赘以及K-L分级严重程度上差异有统计学意义(P0.05),二型一型三型;外侧胫骨骨赘的差异比较,P=0.071;外侧滑车骨赘的差异比较,P=0.63;其他X线表现在3种证型之间的差异亦无统计学意义。结论:膝骨关节炎中医证型与放射学表现有一定的相关性,在外侧髌骨骨赘、胫骨髁间骨赘方面,表现为本研究中医分型中的二型最严重,一型其次,三型最轻。可以推测中医辨证分型中的脾肾两虚、湿注骨节证的辨证依据中可以加入X线表现骨赘生成明显,而且此证型属于放射学诊断的较严重期。     

关节镜诊断和治疗膝关节骨关节炎

自１９９０年７月￣１９９５年７月，作者对７９例（９１膝）膝关节骨关节炎（ＯＡ）患者进行关节镜检查及镜下清理术。镜检结果：２３例（２７膝）获得早期诊断，关节镜分级与临床表现呈正相关，与Ｘ线片改变程度的符合率较低（４７．１％）。随访２￣５年，平均３．９年。术后综合评估：１￣２年，优良率７７．２％，２年以上优良率６０．８％。软骨退变程度与疗效关系：术后１￣２年优良率：软骨Ｉ度退变１００％、Ⅱ度７１．４％     

Hoffa骨折的CT分型

目的 介绍一种新的Hoffa骨折CT分型,并对Hoffa骨折的CT分型与Letenneur X线分型的组间一致性进行比较. 方法 随机选取2008年1月至2011年12月收治的20例Hoffa骨折患者的影像学资料(膝关节正、侧位X线片和股骨髁CT三维重建片),呈递给20位由高级、中级和初级临床医师组成的阅片者,以同样的流程分别根据Letenneur X线分型和新的CT分型对Hoffa骨折进行分类,采用加权Kappa系数进行组内一致性检验,比较多个阅片者之间的两种分型的一致性. 结果 20位阅片者对20例Hoffa骨折患者的CT分型:Ⅰ型占66.0％,Ⅱ型占30.5％,Ⅲ型占3.5％.Ⅰ型骨折中涉及b区域的Ⅰb型最多,占50.0％,Ⅰa型占19.0％,Ⅰc型占31.0％；Ⅱ型粉碎性骨折中粉碎骨折块也多出现在b区域；涉及b区域的骨折在CT分型中总的发生率是67.0％.X线分型:Ⅰ型占31.4％,Ⅱ型占14.3％,Ⅲ型占28.0％,Ⅳ型占26.3％.多个阅片者之间CT分型一致性(Kappa=0.681)较X线分型更高(Kappa=0.261).结论 对于Hoffa骨折,新的CT分型一致性优于X线分型,尤其对于粉碎性骨折患者.     

MRI在膝关节骨关节炎诊断中的应用评价

这项研究的目的是ＭＲＩ与常规最基本的Ｘ线平片比较，来评价ＭＲＩ在膝关节ＯＡ诊断中的应用价值，并设立一套符合病理进程、反映临床严重程度的分期，使膝关节ＯＡ诊断规范化。２８例住院治疗的膝关节ＯＡ患者，在术前进行膝ＭＲＩ、站立位Ｘ线片检查，为临床评定分期；利用关节置换或钻孔减压术中取出的骨为标本，做光镜观察并与ＭＲＩ、Ｘ线片一一对照。（１）ＭＲＩ与病理对照ＭＲＩ的符合率为８１．３％，灵敏度为８５．２％，特异度为７６．０％。均高于Ｘ线片的符合率（５２．８％），灵敏度（５１．６％），特异度（６０．０％）。（２）ＭＲＩ能反映膝ＯＡ的最早的病理改变是纤绒样变（ｆｉｂｒｉｌａｔｉｏｎ）。（３）依照病理演进过程将膝ＯＡ的ＭＲＩ表现分为四期，统计分析证实与临床分期有良好对应关系。（４）膝关节ＯＡ常伴有半月板退变，本组占７１．２８％。     

成年人髌股关节痛的X线改变

目的观察成年人髌股关节痛的Ｘ线改变。方法收集临床诊断为髌骨软骨软化或髌股关节骨性关节病的成年患者６５例,共计７２侧膝关节。摄屈膝３０侧位片和髌骨轴位片,进行Ｉｎｓａｌｌ－Ｓａｌｖａｔｉ和Ｍｅｒｃｈａｔ测量,并与对照组进行比较。结果两组髌骨高度的平均值比较,差异有显著性意义（ｔ检验,ｔ＝２．１５６,Ｐ＜０．０５）;两组髌骨指数平均值比较,差异有非常显著性意义（ｔ检验,ｔ＝０．６６８,Ｐ＜０．０１）;两组髌骨厚度平均值比较,差异有非常显著性意义（ｔ检验,ｔ＝４．８４２,Ｐ＜０．０１）;两组髌股协调角平均值比较,差异有非常显著性意义（ｔ检验,ｔ＝３．２５１,Ｐ＜０．０１）;两组髌股指数平均值比较,差异有非常显著性意义（ｔ检验,ｔ＝３．８０５,Ｐ＜０．０１）。５１侧髌骨Ｗｉｂｅｒｇ分型为稳定性较差的Ⅲ型。有４２侧膝关节有１～５种髌骨不稳定的Ｘ线其它旁证。结论成年髌股关节痛患者的髌股对线、对位、髌骨稳定性、髌骨运动轨迹均有异常。因此,对髌股关节痛患者要查明原因,针对病因进行治疗。Ｍｅｒｏｈａｔ位Ｘ线图像对髌股关节疾病的诊断、手术病例和手术方式的选择,以及对手术成败原因的评价具有重要意义。     

胫骨高位截骨术对髌股关节软骨病变的影响

目的研究胫骨内侧高位截骨术对髌股关节软骨病变的影响。方法回顾性分析自2014年1月至2018年12月诊断为膝骨关节炎合并髌股关节Iwano分级Ⅰ～Ⅲ级的86例患者,行关节镜及胫骨内侧高位截骨术,比较术后髌股关节的软骨改变。所有患者术前查体均为膝内侧疼痛,无髌股关节疼痛,膝正位X线片示内侧间室骨关节炎,髌骨轴位、侧位X线片可见髌股间隙变窄。术中使用关节镜探查髌股关节时,根据国际软骨修复协会软骨损伤分级(international cartilage repair society, ICRS)将患者分为A组35例(ICRS 0～Ⅰ级),其中男性9例,女性26例,平均年龄(55.66±4.66)岁;B组51例(ICRSⅡ～Ⅲ级),其中男性21例,女性30例,平均年龄(55.90±4.44)岁。所有患者均进行胫骨内侧高位截骨矫正力线,建议截骨处愈合后再次手术取出内固定钢板。比较两组患者在初次截骨手术和再次取出内固定手术时视觉模拟评分(visual analogue scale, VAS)、西大略湖麦克马斯特大学(Western Ontario and McMaster universities, WOMAC)骨关节炎指数评分和髌股关节Kujala评分差异;比较每组患者在截骨前后的Iwano分级和镜下ICRS分级差异。结果两组患者在初次截骨术和再次取出内固定手术时VAS评分、WOMAC评分骨关节炎指数评分和Kujala评分比较,差异均有统计学意义(P0.05);每组患者截骨手术前后对比,术后髌股关节ICRS分级较术前有增长趋势,但Iwano分级和镜下ICRS分级比较差异无统计学意义(P0.05)。非劣性检验Kujala评分结果表明B组术后评分并不比A组差。结论对于内翻膝骨关节炎无髌股关节症状的患者,如果髌股关节软骨分级为ICRS 0～Ⅲ级,仍然可采取胫骨内侧高位截骨术,短期不会加重髌股关节炎的临床症状,且功能评分得到改善。     

膝骨关节炎影像学分级同胫股及髌股关节轴线角相关性分析

目的:探讨膝骨关节炎影像学分级与胫股及髌股关节轴线角的相关性。方法:回顾性分析2018年9月至2020年12月行立位双下肢X线及膝关节侧位片检查的中老年KOA患者739例(1 026膝)。其中K-L0级患者63例(95膝);K-L 1级100例患者(130膝);K-L 2级161例患者(226膝);K-L 3级187例患者(256膝);K-L 4级228例患者(319膝)。依据膝关节中心和髋关节中心与踝关节中心连线的相对位置将患膝分为内翻组844膝及外翻组182膝。根据Install-Salvati法将患膝重新分为高位髌骨(髌骨高度>1.2 mm)347膝、中位髌骨(髌骨高度0.8～1.2 mm)561例、低位髌骨(髌骨高度<0.8 mm)118膝3组。测量并比较各组股骨下角,胫骨上角,股骨颈干角,股骨胫骨角,关节间隙角,髋-膝-踝角,髌骨股骨角及髌骨高度。结果:(1)在内翻型KOA组中,不同K-L分级患者的髋-膝-踝角、胫股角、股骨下角、胫骨上角、关节间隙角、股骨颈干角比较,差异有统计学意义(P<0.05)。髋-膝-踝角、胫股角、股骨下角、胫骨上角、关节间隙角与K-...     

髋关节后脱位合并股骨头骨折的诊断与治疗

作者收治髋关节后脱位１６４例，其中合并股骨头骨折者２６例，占１５．９％。按Ｐｉｐｋｉｎ法分类：Ⅰ型１０例，Ⅱ型６例，Ⅲ型８例。２４例急诊摄Ｘ线片，早期确诊２２例，漏诊２例。另２例在创伤后股骨头即自动复位，急诊未摄片耐致漏诊。作者认为，为明确诊断除摄常规髋关节前后位Ｘ线片外，还需摄髋关节４５度或６０度斜位片，蛙式正位片ＣＴ导向下的骨盆斜位片，以协同观察股骨头骨折线的移位程度及关节内的游离体。非手术治     

膝骨关节炎肌骨超声与X线片表现的比较与分析

目的 :比较分析膝骨关节炎患者肌骨超声与X线片的表现特点,研究两者在膝骨关节炎诊断中各自的优势。方法:收集整理2015年2月至2015年5月门诊病历,按照纳入标准和排除标准收集膝关节骨性关节炎诊断患者的肌骨超声以及X线片表现,共纳入57例(66膝),其中女48例,男9例,年龄41~78岁,平均(58.9±9.8)岁,主要症状以双膝或单膝关节疼痛、屈伸不利、有确切的压痛点为主,平均病程(13.6±3.0)个月。对所收集的数据进行统计分析。结果:膝关节X线片Kellgren-Lawrence分级Ⅰ级患者的肌骨超声检查结果:滑膜增生9膝,关节积液20膝,半月板病变13膝,髌下脂肪垫炎症5膝,髌韧带病变8膝。Kellgren-Lawrence分级Ⅱ级患者肌骨超声检查结果:滑膜增生20膝,关节积液31膝,半月板病变22膝,髌下脂肪垫炎症16膝,髌韧带病变17膝。Kellgren-Lawrence分级Ⅲ级患者的肌骨超声表现:滑膜增生6膝,关节积液6膝,半月板病变7膝,髌下脂肪垫炎症7膝,髌韧带病变5膝。结论:肌骨超声可以很好地反应早期和中期膝骨关节炎患者膝关节周围软组织的病理变化,可以更好地定位膝关节骨性关节炎的病变位置,并且在X线片表现不明显时做到早期的病变发现。在临床过程中应将肌骨超声应用于膝骨关节炎的诊断之中。     

儿童Perthes病不同分型方法的比较研究

儿童Ｐｅｒｔｈｅｓ病即儿童股骨头缺血性坏死，是儿童骨性疾病中的常见病，多见于３～９岁儿童，好发于男孩。这种病的病因尚不十分清楚，治疗方法不一，晚期病变致残率高。诊断主要是通过临床症状、体征及Ｘ线片，其中以Ｘ线片最为重要。Ｐｅｒｔｈｅｓ病的分型，目前常用的是Ｃａｔｔｅｒａｌｌ分型法。Ｃａｔｔｅｒａｌｌ根据病理改变，结合Ｘ线片上股骨头受累情况，将股骨头坏死分为四型。其中Ⅰ、Ⅱ型预后较好，不需特殊治疗；Ⅲ、Ⅳ型股骨头受累明显，预后不佳，应给予包容治疗。但有学者对Ｃａｔｔｅｒａｌｌ分型法的可靠性提出质疑…     

Distribution of bone mineral density at the proximal tibia in knee osteoarthritis

One hundred and thirteen knees with osteoarthritis (OA) were studied to assess the distribution of bone mineral density (BMD) in the proximal tibia and the potential relation between osteoarthritis and osteoporosis in evaluating hip BMD. All patients had severe knee pain and were diagnosed with Kellgren and Lawrence grade IV osteoarthritis. According to the magnitude of the axial deformity, four categories were created: varus>10 degrees ( 28.3%), varus 4-10 degrees (38.9%), aligned 180 +/- 3 degrees (13.3%), and valgus>4 degrees (19.5%). For each category, the medial and lateral proximal tibial density were assessed. BMD was measured at the femoral neck and at 14 regions of interest (ROI) in the proximal part of the tibia using dual X-ray absorptiometry. Based on the femoral neck BMD, patients were classified according to the World Health Organization (WHO) definition of osteoporosis. The mean knee BMD was positively correlated with the hip BMD value (knee BMD m = 0.38 + 0.73 x hip BMD, r = 0.60, P<0.001). The knee BMD distribution of the 113 patients was negatively correlated with the axial deformity (BMD MT-LT = 5.15 - 0.027 x HKA, r = 0.77, P<0.0001). In the varus deformity, BMD of the medial side was higher than that of the lateral side with an important asymmetry (0.587 g/cm2). This asymmetry was also found in the valgus deformity for the lateral side but was less important (-0.112 g/cm2). With equal deformity, the asymmetry of BMD was higher in varus deformity (0.587 g/cm2) than in valgus deformity (-0.112 g/cm2). Asymmetry of the knee BMD distribution revealed that progression of the deformity (either varus or valgus) with joint space narrowing led to an increase in the medio-lateral difference of the proximal tibia density. Lesser severity of Kellgren and Lawrence grades may reveal different results. Twenty patients with osteoporosis developed knee osteoarthritis (OA) and the relation between osteoporosis and knee OA remains unclear.     

Surgical treatment for permanent dislocation of the patella in adults

Permanent dislocation of the patella in adults is a rare condition that presents with complete irreducible lateral dislocation of the patella, combined with secondary changes, such as valgus deformity and leg-length discrepancy. Because these secondary changes cannot heal spontaneously after skeletal maturation if left untreated, the patients frequently possess pathology not limited to the knee joint and extending to the whole lower extremity, such as malalignment or leg-length discrepancy, that can develop into osteoarthritis of the knee. However, to our knowledge, few surgeons advocate the significance of correcting the malalignment in treating adult patients. We treated a 34-year-old woman with permanent dislocation of the patella in a 2-stage surgery, consisting of first-stage correction of valgus deformity and limb shortening using a Ilizarov external fixator and second-stage realignment of the dislocated patella over the trochlea. A follow-up examination conducted 3 years after the second operation revealed plantigrade gait with normal alignment of the lower extremity without limping and medial thrust. The patella was tracking centrally in the patellofemoral groove. Radiographs showed a neutral mechanical axis of the lower extremity, no evidence of patellar subluxation, and no deteriorating osteoarthritic changes at the tibiofemoral joint. This case highlights the importance of correcting secondary changes, such as valgus deformity and leg-length discrepancy, to reduce the risk of future osteoarthrosis and postoperative dislocation, especially when these deformities are substantial.     

Frontal plane knee alignment is associated with a longitudinal reduction in patella cartilage volume in people with knee osteoarthritis

OBJECTIVES: Varus-valgus alignment of the knee is increasingly becoming recognised as an important biomechanical variable in patellofemoral osteoarthritis (OA). The aim of this study was to determine the cross-sectional and longitudinal relationships between frontal plane knee alignment and patella cartilage volume in people with knee OA. METHODS: Ninety-nine adults with symptomatic knee OA were recruited using a combined strategy including referral from specialist centres, arthritis support groups and media advertising. Both baseline and follow-up X-rays and magnetic resonance imaging (MRI) were performed 2 years apart. Knee alignment and patella cartilage volume were determined from X-ray and MRI, respectively. RESULTS: Annual change in knee alignment was negatively associated with an annual change in the total patella cartilage volume before (P=0.002) and after (P=0.003) adjustment for potential confounders over an average of a 1.9-year period. For every 1 degrees change towards valgus direction, there was a 23.4-mm(3) [95% confidence interval (CI) 8.1 mm(3)-38.7 mm(3)] annual reduction in the total patella cartilage volume. CONCLUSION: This study is the first to clearly demonstrate and quantitate the annual reduction in patella cartilage volume that occurs as knee alignment becomes increasingly valgus in an osteoarthritic cohort. Interventions that aim to minimise change towards valgus alignment may reduce the risk for the onset and progression of patellofemoral OA.     

Knee or Spine Surgery First? A Survey of Treatment Order for Patients With Concurrent Degenerative Knee and Lumbar Spinal Disorders

BackgroundTotal knee arthroplasty (TKA) and lumbar spine surgery have been reported to affect the outcomes of each other. There is insufficient evidence to guide the choice of treatment order for patients with both disorders that are equally symptomatic.MethodsFive clinical scenarios of concurrent, advanced, degenerative knee and lumbar spinal disorders were designed to survey surgeons’ choices of treatment order and rationale. The spinal disorder was consistently degenerative lumbar spinal stenosis, but the knee conditions varied to include (1) osteoarthritis (OA) with varus deformity, (2) OA with valgus deformity, (3) rheumatoid arthritis with a severe flexion contracture, (4) OA without deformity, and (5) bilateral OA with windswept deformities. The survey was distributed to selected clinical members of the Knee Society and Scoliosis Research Society in North America. The surgeons’ choices were compared among the 5 scenarios, and their comments were analyzed using text-mining.ResultsResponses were received from 42 of 74 (57%) knee arthroplasty surgeons and 55 of 100 (55%) spine surgeons. The percentages of knee arthroplasty surgeons recommending “TKA first” differed significantly among scenarios: 29%, 79%, 55%, 7%, and 81% for scenarios 1 through 5, respectively (P < .001). A similar pattern was noted for the spine surgeons.ConclusionFor patients with concurrent degenerative knee and lumbar spinal disorders, the severity and type of knee deformity influenced the preference of treatment order in both specialties. Severe valgus deformity and windswept deformities of the knee would drive the decision toward “TKA first.”     

基于临床科研共享系统建立膝骨关节炎分级模型

目的:运用有序Logistic回归分析筛选出膝骨关节炎分级的影响因素,建立膝骨关节炎分级模型,为临床膝骨关节炎分级的测评提供工具。方法:对2014年9月18日至2016年4月26日就诊于中国中医科学院望京医院的753例膝骨关节炎病例使用单因素、多因素有序Logistic回归分析,构建模型公式并进行评估。结果:研究发现与膝骨关节炎分级相关的影响因素为13项。其中危险因素包括高龄、肥胖、病程长、反复发作、下肢畸形、股四头肌萎缩,同时VAS评分、WOMAC指数、中医证候量表积分与分级程度呈正相关关系,单膝疼痛、疼痛范围局限、膝关节活动度与分级程度呈负相关关系。本研究构建出膝骨关节炎分级模型,评估检验效能良好(训练集AUC=0.860,测试集AUC=0.879)。结论:研究建立了膝骨关节炎分级模型,且在初步评估下发现具有良好的预测膝骨关节炎分级的能力。     

人工全膝关节置换术治疗终末期膝关节病变合并膝外翻畸形的手术技巧及临床疗效评价

目的探讨对终末期膝关节病变合并膝外翻畸形患者行经髌旁内侧入路人工全膝关节置换(total kneearthroplasty,TKA)时膝外翻畸形矫正方法及临床疗效。方法 1998年11月-2010年10月,收治64例72膝合并膝外翻畸形的终末期膝关节病变患者。男18例,女46例;年龄23～82岁,平均62.5岁。骨关节炎44例49膝,类风湿性关节炎17例20膝,血友病性关节炎2例2膝,创伤性关节炎1例1膝。双膝8例,单膝56例。膝关节屈伸活动度为(82.2±28.7)°,X线片测量股胫角为(18.0±5.8)°。膝关节学会评分系统(KSS)临床评分为(31.2±10.1)分,功能评分(37.3±9.0)分。根据Krackow膝外翻分型标准:Ⅰ型65膝,Ⅱ型7膝。手术经髌旁内侧入路,采用常规方法行股骨及胫骨截骨,Ranawat技术进行软组织松解。6例7膝采用保留后交叉韧带型假体,54例60膝采用后稳定型假体,4例5膝采用髁限制型假体。结果术后患者切口均Ⅰ期愈合。1例血友病性关节炎合并严重膝外翻畸形(股胫角41°)、屈曲挛缩20°的患者术后出现腓总神经麻痹,经保守治疗1年后神经功能恢复。1例术后2年发生深部感染,行二期翻修术后治愈。患者术后均获随访,随访时间1～13年,平均4.9年。末次随访时X线片示股胫角为(7.0±2.5)°,与术前比较差异有统计学意义(t=15.502,P=0.000)。KSS临床评分为(83.0±6.6)分,功能评分(85.1±10.5)分,膝关节屈伸活动度为(106.1±17.0)°,与术前比较差异均有统计学意义(P0.05)。5例遗留12～15°膝外翻畸形,但患膝关节功能良好。结论通过恰当的术中截骨和软组织平衡,采用经髌旁内侧入路TKA治疗合并膝外翻畸形的终末期膝关节病变可有效改善膝外翻畸形和恢复关节功能,临床疗效满意。     

Distal femoral varus osteotomy for osteoarthritis of the knee

BACKGROUND: Distal femoral varus osteotomy is a procedure that is performed for the treatment of lateral-compartment osteoarthritis of the knee as well as for correction of the associated valgus deformity. However, its role remains controversial and its efficacy in the treatment of associated patellofemoral arthritis has not been well studied. The purpose of the present study was to evaluate the outcome after distal femoral osteotomy performed for the treatment of painful genu valgum and to assess the influence of patellofemoral arthritis on the results. METHODS: Thirty patients (thirty knees) were managed with distal femoral varus osteotomy for the treatment of noninflammatory lateral-compartment arthritis of the knee associated with a valgus deformity. Twelve knees had isolated lateral-compartment arthritis, ten had mild-to-moderate degenerative changes in the other two compartments, and eight knees had severe patellofemoral arthritis in addition to lateral-compartment disease. The osteotomy site was fixed with a 90 degrees blade-plate. After a mean duration of follow-up of ninety-nine months, all patients were evaluated with use of the Hospital for Special Surgery knee-rating system and a physical examination. RESULTS: At the time of the most recent follow-up, twenty-five patients (83%) had a satisfactory result and two had a fair result according to the Hospital for Special Surgery rating system. The remaining three patients had had a conversion to a total knee arthroplasty. With conversion to total knee arthroplasty as the end point, the cumulative ten-year survival rate for all patients was 87% (95% confidence interval, 69% to 100%). Improvement in patellar tracking, which persisted at the time of the latest follow-up, was observed in seven of the eight knees with associated severe patellofemoral arthritis. CONCLUSIONS: Distal femoral varus osteotomy with blade-plate fixation can be a reliable procedure for the treatment of lateral-compartment osteoarthritis of the knee associated with valgus deformity. The result of the osteotomy does not appear to be affected by the presence of severe patellofemoral arthritis.     

High tibial osteotomy. A prospective clinical and roentgenographic review

In a prospective clinical and roentgenographic analysis of 79 knees treated by a valgus closing wedge high tibial osteotomy, the average follow-up period was 5.8 years (three to nine years); 80% of the patients had good or excellent results. Correction to a femorotibial angle between 6 degrees and 14 degrees of femorotibial valgus was associated with an optimal clinical result. Undercorrection to less than 5 degrees of femorotibial valgus was associated with a high (62.5%) failure rate. Patients whose distal femur had a femoral shaft-transcondylar (FS-TC) angle of less than 9 degrees have an increased incidence of undercorrection. A poor prognosis was noted in knees whose patellofemoral joint preoperatively had moderate or severe roentgenographic evidence of osteoarthritis (OA) when compared to the group whose patellofemoral compartment had no or mild roentgenographic evidence of OA. Accurate femorotibial realignment was essential for success. The slope of the distal femoral articular surface, the FS-TC angle, affects the degree of correction and should be considered in preoperative planning.     

高寒地区城市汉族人群膝骨关节炎情况调查

目的研究高寒地区膝关节骨关节炎的患病情况、影响因素及防治措施。方法采用整群随机抽样的方法对社区内年龄在41～70岁的具有常住户口的汉族人群,分期分批进行问卷调查、体格检查和X线摄片。结果共有522名被调查者合格,男253名,女269名,平均年龄53.4岁,诊断膝关节炎者共100人,平均患病率19.16%,男性为11.07%,女性为26.77%。各年龄组以61～65岁组患病率最高,为36.07%,膝关节各个部位患病率,内侧胫股关节(20.5%)>外侧胫股关节(13.31%)>髌股关节(8.91%)。左右两侧无明显的差异。双侧同时出现异常的患病率分别为18.39%,11.11%和6.32%。工作姿势即站、蹲、坐、弯腰以及烟酒和日常饮食习惯与本病缺乏相关性。结论高寒地区城市汉族人群膝关节骨关节炎患病率较高,且以61～70岁为最高,其患病率与姿势及烟酒和日常饮食习惯无关;膝关节骨关节炎的X线异常为对称性。     

Static knee alignment and its association with radiographic knee osteoarthritis

OBJECTIVES: Although knee alignment is associated with the progression of knee osteoarthritis (OA), it is unclear which features that characterize radiographic OA are related to alignment. The aim of this study was to examine the relationship between static knee joint alignment (measured as a continuous variable) and the radiographic features of knee OA (joint space narrowing and osteophytes). METHODS: One hundred and twenty one adults with symptomatic knee OA were recruited using a combined strategy including referral from specialist centres, arthritis support groups and media advertising. X-rays were performed to classify the severity of disease and to determine static knee alignment. RESULTS: Increasing varus knee alignment was associated with increasing risk of medial compartment joint space narrowing (P < 0.001) and osteophytes (P = 0.005). Increasing valgus knee alignment was associated with an increased risk for lateral compartment joint space narrowing (P < 0.001) and osteophytes (P = 0.002). CONCLUSION: This study has demonstrated that the static knee angle, measured as a continuous variable, is an important determinant of the compartment-specific features of radiographic knee OA. Further work is required to determine whether interventions aimed at correcting these relatively minor levels of varus and valgus angulation will have an effect on the risk of tibiofemoral OA.