下肢全长负重位X线检查在膝关节炎内外翻畸形中的临床价值

目的:探讨膝关节炎患者下肢全长负重位X线片对膝内、外翻畸形诊断的临床价值。方法:选取32例临床诊断为膝关节炎51膝分别拍摄下肢全长负重X线片,测量下肢力线和机械轴偏距(mechanical axis offset distance,MAD),解剖学股胫骨角(anatomical femor-tibial angle,aFTA),股骨远端力学外侧角(mechanical lateral distal femoral angle,mLDFA),胫骨近端力学内侧角(mechanical medial proximal tibial angle,mMPTA),对图像数据进行分析,对膝关节炎进行X线K/L分级,通过SPSS 17.0统计对下肢力线各参数与关节炎的相关性进行分析。结果:①膝关节下肢全长负重位X线片显示,关节有不同程度骨质增生,关节间隙变窄。②51膝骨关节炎中确诊膝内翻畸形38膝(74.51.%)和膝外翻畸形8膝(10.42%),5膝均无内外翻畸形。③膝关节炎X线K/L分级显示,0级:5膝(9.8%),I级:12膝(23.5%),II级:22膝(43.1%);III级:9膝(17.6%);IV级:3膝(59%)。④膝内翻组中股骨内翻7膝(18.42%),胫骨内翻18膝(47.36%),股骨、胫骨均内翻13膝(34.21%);膝外翻组中股骨外翻6膝,股骨、胫骨均外翻2膝。⑤在膝内翻组中,aFTA与骨关节炎X线K/L分级呈正相关(B值=0.132,t=2.648,P=0.012,P<0.05)。结论:下肢全长负重X线显示下肢结构清晰、完整,通过测量下肢力线参数评估,可全面诊断膝关节炎的内翻畸形或外翻畸形,膝内翻中以胫骨内翻显著,膝外翻中则以股骨外翻显著。因此,膝关节骨性关节炎的下肢全长负重X线检查具有较高的临床价值。

Clinical Value of Knee Arthritis for Knee Varus or Valgus Deformity with Full-Length Weight-Bearing X-Ray of Lower Limbs

Objective:To investigate the clinical value of full-length weight-bearing X-ray examination of lower limbs in knee osteoarthritis for knee varus or knee valgus deformity.Methods:51 knee joints of 32 patients diagnosed as osteoarthritis of knee joint were studied. The gastrointestinal-DR integrated X-ray examination equipment was used to take the full-length weight-bearing X-ray film of the affected limb, and the lower limb force line and mechanical axis offset distance(MAD),anatomical femor-tibial angle(aFTA),mechanical medial proximal tibial angle(mMPTA),mechanical lateral distal tibial angle(mLDFA) were measured, and the image data were analyzed and evaluated. To assessed the knee osteoarthritis by X-ray grading of the Kellgren-Lawrence criteria,and was performed on correlation between the parameters of lower limb alignment and knee osteoarthritis analysis by SPSS 17.0.Results:①The full-length weight-bearing X-ray films of 51 knees showed, all the knees had different degrees of hyperosteogeny and the joint space became narrow.②38 cases(74.51.%)of knee varus deformity and 8 cases(10.42%)of knee valgus deformity in 51 cases of knee osteoarthritis were confirmed, 5 cases of knees neither varus deformity also didn’t valgus deformity. ③Knee osteoarthritis by X-ray K/L criteria were 5 cases(9.8%)with Grade 0, 12 cases(23.5%)with Grade I, 22 cases(43.1%)with Grade II, 9 cases(17.6%)with Grade III, 3 cases(5.9%)with Grade IV.④In knee varus deformity group, the femoral varus were 7 knees(18.42%), the tibial varus were 18 knees(47.36%), both femora and tibial were varus with 13 knees(34.21%).In knee valgus deformity group, the femoral valgus were 6 knees, both femora and tibial were valgus with 2 knees.⑤In the knee varus group, aFTA was positively correlated with the X-ray K/L grade of osteoarthritis(B=0.132, t=2.648, P=0.012, P<0.05).Conclusion:The full full-length weight-bearing x-ray display of lower extremity is not only clear but also complete. The diagnosis of varus or valgus deformity of knee arthritis is more comprehensive by measuring the parameters of force line of lower extremity. In the knee varus deformity deformity, tibial varus was significant.while In the knee valgus deformity,femoral valgus was significant.Therefore,full-length weight-bearing X-ray examination of lower limbs in knee osteoarthritis is high clinical value.