国人膝骨关节炎患者关节线不均匀沉降的影像学测量及影响因素分析

目的通过测量膝骨关节炎（KOA）患者X线基本参数，探究膝关节线重塑及不均匀沉降规律及影响因素。 方法本研究共纳入2015年1月至2016年12月吉林大学中日联谊医院收治的148例（192膝）KOA患者，其中男性50例（59膝），女性98例（133膝）；年龄41~81岁，平均（64±9）岁。将所有患者按年龄分成<60岁组和≥60岁组，并按K-L分级对KOA患者进行分型。在膝关节正位X线片上测量解剖标志到膝关节线的距离、股骨髁高度及胫骨平台高度并进行统计分析。 结果股骨内收肌结节、腓骨头高点到膝关节线的距离分别为（50±5）mm（ATJL）、（17±5）mm（FHJL）。股骨内髁（MFCA）、股骨外髁（LFCA）、胫骨内侧平台（MTPA）、胫骨外侧平台（LTPA）高度分别为（49±5）mm、（47±6）mm、（4±5）mm、（9±4）mm。股骨髁宽度（FW）为（93±7）mm，并与ATJL呈正相关（r=0.651，P<0.001）。不同性别间FW、ATJL、MFCA、LFCA差异具有统计学意义（P<0.05）。<60岁和≥60岁组间MTPA差异具有统计学意义（t=2.195，P=0.029）。不同K-L分级MTPA差异具有统计学意义（F=4.082，P=0.003），且MTPA与K-L分级呈负相关（r=-0.241，P=0.001）。 结论胫骨内侧平台高度与KOA严重程度呈负相关，可以用来评价KOA的严重程度。在KOA患者中ATJL与FW具有相关性，随着年龄的增长股骨髁及胫骨外侧平台高度未发生明显变化，胫骨内侧平台高度显著降低，提示胫骨平台随年龄增长存在不均匀沉降。

Imaging measurements and influencing factors of non-uniform settlement of joint line in patients with knee osteoarthritis

ObjectiveTo explore the rule and influencing factors of knee joint line remodeling as well as non-uniform settlement through measuring basic parameters of X-ray in patients with knee osteoarthritis (KOA). MethodsA retrospective study was done in148 patients (total 192 knees) treated in China–Japan Union Hospital of Jilin University from January 2015 to December 2016, including 50 males (59 knees) and 98 females (133 knees). Aged from 41 to 81 years with a mean age of 64±9 years. Patients were divided into <60 years Group and ≥60 years Group. All knee joints were classified by K-L grade. The distance between the knee anatomical landmarks and the knee joint, the altitude of femoral condyle and tibial platform were first measured and then analyzed on a standard knee anteroposterior radiograph. ResultsThe distances from femoral adductor tubercle and the apex of fibular head to knee line were (50±5) mm (ATJL) and (17±5) mm (FHJL), respectively. The altitudes of medial and lateral femoral condyle, medial and lateral tibial plateau were (49±5) mm (MFCA), (47±6) mm (LFCA), (4±5) mm (MTPA) and (9±4) mm (LTPA), respectively. The femoral width (FW) was (93±7) mm which was positively correlated with ATJL (r=0.651, P<0.001). The differences of FW, ATJL, MFCA, LFCA in gender were statistically significant (P<0.05). There was statistically different in MTPA between two different age groups (t=2.195, P=0.003). According to the K-L grade, there existed statistically significant difference between two groups (F=4.082, P=0.003), and MTPA was negatively correlated with the K-L grade (r=-0.241, P=0.001). ConclusionsThe MTPA is negatively correlated with the severity of KOA, which can be used to evaluate the severity of KOA. There was a correlation between ATJL and FW in KOA patients. The height of the lateral femoral condyle and lateral tibial plateau did not change significantly with increased age, and the height of medial tibial plateau decreased significantly, suggesting non-uniform settlement of tibial plateau with age.