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-...

Correlation analysis between imaging classification of varus knee osteoarthritis and axis angle of tibiofemoral and patellofemoral joints

Objective To explore correlation between imaging classification of knee osteoarthritis (KOA) and axis angle of tibiofemoral and patellofemoral joints.Methods A retrospective analysis of 739 middle-aged and elderly patients with KOA (1 026 knee joints) who underwent vertical X-ray examination of both lower limbs and lateral knee joints from September 2018 to December 2020. Among them,63 patients with K-L 0 grade (95 knee joints),100 patients with K-L 1 grade (130 knee joints),161 patients with K-L 2 grade (226 knee joints),187 patients with K-L 3 grade (256 knee joints),and 228 patients of K-L 4 grade (319 knee joints). According to relative position of knee joint center and line between hip joint center and ankle joint center,the affected knee was divided into varus group(844 knees joints) and valgus group (182 knees joints). According to Install-Salvati method,the affected knee was divided into three groups,such as high patella (patella height>1.2 mm,347 knees joints),median patella (patella height ranged from 0.8 to 1.2 mm,561 knees joints),and low patella (patella height<0.8 mm,118 knees joints). Lower femur angle,upper tibia angle,femoral neck shaft angle,femoral tibial angle,joint gap angle,hip-knee-ankle angle,patella-femoral angle and patella height among different groups were observed and compared.Results (1) In varus KOA group,there were statistical differnces in hip-knee-ankle angle,tibiofemoral angle,lower femoral angle,upper tibial angle,joint space angle,and femoral neck shaft angle of patients with different K-L grades (P<0.05). Hip-knee-ankle angle,tibiofemoral angle,lower femoral angle,upper tibial angle,joint space angle and K-L grade were significantly positively correlated at 0.01(P<0.05);femoral neck shaft angle and K-L grade showed negative correlation at 0.01(P<0.05). (2) In valgus KOA group,hip-knee-ankle angle,there were statistical differences in tibiofemoral angle,inferior femoral angle,superior tibial angle,joint space angle,and femoral neck shaft angle of patients with different K-L grades(P<0.05). Hip-knee-ankle angle,tibiofemoral angle,lower femoral angle,upper tibial angle,and femoral neck shaft angle showed negative correlation with K-L grades at level of 0.01 (P<0.05);joint gap angle and K-L grades showed significantly positive correlation at level of 0.01(P<0.05). (3) In high patella group,there were statistically differences in patellar height and patellar femoral angle of different K-L grades(P<0.05);there were no statistical difference in patella height and patellar femoral angle of different K-L grades in median patella group. There was no significant difference in patella heightin low patella group with different K-L grades(P>0.005),and there was statistical difference in patellofemoral angle(P<0.05). Patellar height and patella-femoral angle of high patella group were significantly positively correlated with K-L grades at the level of 0.01 (P<0.05);patella height and patella-femoral angle were not correlated with K-L grades in median patella group(P>0.005). There was no correlation between height of patella and K-L grade in low patella group (P>0.005). There was significant negative correlation between patella-femoral angle and K-L grade at level of 0.05 (P<0.05).Conclusion Inferior femoral angle,tibiofemoral angle,joint gap angle,hip-knee-ankle angle,femoral neck shaft angle and high patella are related to K-L classification of varus KOA,which could be used for early diagnosis and provide objective data for efficacy analysis of conservative treatment.