[1]吴海贺,左建林,李钊,等.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[J].中华老年骨科与康复电子杂志,2018,(02):105-110.[doi:10.3877/cma.j.issn.2096-0263.2018.02.008]
　Wu Haihe,Zuo Jianlin,Li Zhao,et al.Imaging measurements and influencing factors of non-uniform settlement of joint line in patients with knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(02):105-110.[doi:10.3877/cma.j.issn.2096-0263.2018.02.008]
点击复制

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()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2018年02期
页码:
105-110
栏目:
三维影像
出版日期:
2018-03-31

文章信息/Info

Title:
Imaging measurements and influencing factors of non-uniform settlement of joint line in patients with knee osteoarthritis
作者:
吴海贺; 左建林; 李钊; 杨育晖; 刘潼; 高忠礼
130033 长春，吉林大学中日联谊医院骨科
Author(s):
Wu Haihe;  Zuo Jianlin;  Li Zhao;  Yang Yuhui;  Liu Tong;  Gao Zhongli
Department of Orthopaedics, China-Japan Union Hospital, Jilin University, Changchun 130033, China
关键词:
膝关节;  内收肌结节;  不均匀沉降
Keywords:
Knee joint;  Adductor tuberosity;  Non-uniform settlement
DOI:
10.3877/cma.j.issn.2096-0263.2018.02.008
文献标志码:
A
摘要:
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。
Abstract:
Objective To 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). Methods A 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. Results The 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). Conclusions The 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.

参考文献/References:

1 Iacono F, Raspugli GF, Filardo G, et al. The adductor tubercle: an important landmark to determine the joint line level in revision total knee arthroplasty [J]. Knee SurgSportsTraumatolArthrosc, 2016, 24(10): 3212-3217.
2 Gurbuz H, Cakar M, Adas M, et al. Measurement of the knee joint line in Turkish population [J]. Acta Orthop Traumatol Turc, 2015, 49(1): 41-44.
3 Havet E, Gabrion A, Leiberwackenheim F, et al. Radiological study of the knee joint line position measured from the fibular head and proximal tibial landmarks [J]. SurgRadiol Anat, 2007, 29(4): 285-289.
4 武建运, 左建林, 刘潼, 等. 膝骨性关节炎下肢负重位等比例全长X线片测量与分析 [J]. 中国骨伤, 2016, 29(9): 791-794.
5 Liu T, Wang CY, Xiao JL, et al. Three-dimensional Reconstruction method for measuring the knee valgus angle of the femur in northern Chinese adults [J]. J Zhejiang Univ Sci B, 2014, 15(8): 720-726.
6 Maini L, Singh S, Kushwaha NS, et al. Radiographic analysis of the axial alignment of the lower extremity in Indian adult males [J]. JArthroscJoint Surg, 2015, 2(3): 128-131.
7 Laskin RS. Management of the patella during revision total knee replacement arthroplasty [J]. Orthop Clin North Am, 1998, 29(2): 355-360.
8 Laskin RS. Joint line position restoration during revision total knee replacement [J]. Clin Orthop Relat Res, 2002, 404(44): 169-171.
9 Iacono F, Presti M L, Bruni D, et al. The adductor tubercle: a reliable landmark for analysing the level of the femorotibial joint line[J]. Knee Surgery Sports Traumatology Arthroscopy, 2013, 21(12):2725-2729.
10 Sato T, Koga Y, Sobue T, et al. Quantitative 3-dimensional analysis of preoperative and postoperative joint lines in total knee arthroplasty - A new concept for evaluation of component alignment [J]. JArthroplasty, 2007, 22(4): 560-568.
11 Howell SM, Chen J, Hull ML. Variability of the location of the tibial tubercle affects the rotational alignment of the tibial component in kinematically aligned total knee arthroplasty [J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(10): 2288-2295.
12 Herzog RJ, Silliman JF, Hutton K, et al. Measurements of the intercondyle notch by plain film radiography and magnetic resonance imaging [J]. Am J Sports Med, 1994, 22(2): 204-210.
13 Sarmah SS, Patel S, Hossain FS, et al. The radiological assessment of total and unicompartmental knee replacements [J]. JBoneJoint SurgBr, 2012, 94(10): 1321-1329.
14 Maderbacher G, Keshmiri A, Zeman F, et al. Assessing joint line positions by means of the contralateral knee:a new approach for planning knee revision surgery? [J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(11): 3244-3250.
15 张英泽, 李存祥, 李冀东, 等. 不均匀沉降在膝关节退变及内翻过程中机制的研究 [J]. 河北医科大学学报, 2014, 35(2): 218-219.
16 Mcneil CJ, Raymer GH, Doherty TJ, et al. Geometry of a weight-bearing andnon-weight-bearing bone in the legs of young,old,and very old men [J]. Calcif Tissue Int, 2009, 85(1): 22.
17 Sugita T, Kawamata T, Ohnuma M, et al. Radial displacement of the medial meniscus in varus osteoarthritis of the knee [J]. Clin Orthop Relat Res, 2001, 387(387): 171-177.
18 Adams JG, Mcalindon T, Dimasi M, et al. Contribution of meniscal extrusion and cartilage loss to joint space narrowing in osteoarthritis [J]. Clin Radiol, 1999, 54(8): 502-506.
19 Englund M, Guermazi A, Lohmander SL. The role of the meniscus in knee osteoarthritis:a cause or consequence? [J]. Radiol Clin North Am, 2009, 47(4): 703-712.

相似文献/References:

[1]李博　李计东　刘丽君　曲磊　刘丽霞　贾媛媛　王海红　刘军.腓骨近端截骨术与口服药物治疗膝关节骨关节炎的对比研究[J].中华老年骨科与康复电子杂志,2016,(01):32.[doi:10.3877/cma.j.issn.2096-0263.2016.01.007]
　Li Bo,Li Jidong,Liu Lijun,et al.Therapeutic effect analysis of proximal fibular osteotomy for the treatment of patients withknee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):32.[doi:10.3877/cma.j.issn.2096-0263.2016.01.007]
[2]杨朝君 孙智文 田洪涛.腓骨近端截骨术与人工全膝关节置换术治疗内翻型膝关节骨关节炎的短期疗效比较[J].中华老年骨科与康复电子杂志,2016,(01):38.[doi:10.3877/cma.j.issn.2096-0263.2016.01.008]
　Yang Zhaojun,Sun Zhiwen,Tian Hongtao.Comparison on the short term treatment of varus knee osteoarthritis by proximal fibular osteotomy versus total knee arthroplasty[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):38.[doi:10.3877/cma.j.issn.2096-0263.2016.01.008]
[3]吴碧 王跃 郝鹏.腓骨近端截骨术治疗膝关节骨关节炎的研究进展[J].中华老年骨科与康复电子杂志,2016,(01):54.[doi:10.3877/cma.j.issn.2096-0263.2016.01.011]
[4]于风天,魏杰,王晓东.腓骨近端截骨术与胫骨高位截骨术治疗内翻型膝关节骨关节炎的疗效比较[J].中华老年骨科与康复电子杂志,2016,(02):97.[doi:10.3877/cma.j.issn.2096-0263.2016.02.007]
　Yu Fengtian,Wei Jie,Wang Xiaodong..Comparative analysis of curative effect of proximal fibular osteotomy for the treatment of varus knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):97.[doi:10.3877/cma.j.issn.2096-0263.2016.02.007]
[5]白玉,王爱国,骆晓飞.腓骨近端截骨术治疗内侧间室性膝关节骨关节炎的疗效分析与机制探讨[J].中华老年骨科与康复电子杂志,2016,(03):161.[doi:10.3877/cma.j.issn.2096-0263.2016.03.007]
　Bai Yu,Wang Aiguo,Luo Xiaofei.The effect and mechanism of proximal fibular osteotomy in treating medial compartment osteoarthritis of the knee[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):161.[doi:10.3877/cma.j.issn.2096-0263.2016.03.007]
[6]谢学然,朱培丽,乔源鑫,等.腓骨近端截骨联合关节镜下清理治疗中老年膝关节骨关节炎的临床疗效[J].中华老年骨科与康复电子杂志,2016,(04):217.[doi:10.3877/cma.j.issn.2096-0263.2016.04.005]
　Xie Xueran,Zhu Peili,Qiao Yuanxin,et al.Effect of proximal fibular osteotomy combined with arthroscopy debridement in senile knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(02):217.[doi:10.3877/cma.j.issn.2096-0263.2016.04.005]
[7]闫国富,薛晨晖,刘巍.腓骨近端截骨术治疗不同外翻应力角膝关节骨关节炎患者的疗效比较[J].中华老年骨科与康复电子杂志,2017,(01):38.[doi:10.3877/cma.j.issn.2096-0263.2017.01.008]
　Yan Guofu,Xue Chenhui,Liu Wei.Comparison of the VgSA and the efficacy of knee osteoarthritis treated by proximal fibular osteotomy[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):38.[doi:10.3877/cma.j.issn.2096-0263.2017.01.008]
[8]王文革,李仕臣,赵艳东,等.腓骨近端截骨术和胫骨高位截骨术治疗早期膝关节骨关节炎的短期疗效比较[J].中华老年骨科与康复电子杂志,2017,(02):91.[doi:10.3877/cma.j.issn.2096-0263.2017.02.005]
　Wang Wenge,Li Shichen,Zhao Yandong,et al.Early stage comparison of proximal fibula osteotomy and high tibial osteotomy to treat early knee joint osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):91.[doi:10.3877/cma.j.issn.2096-0263.2017.02.005]
[9]姚国军,尹淑梅,赵庆海,等.腓骨近端截骨与关节镜清理治疗膝关节骨关节炎的对比研究[J].中华老年骨科与康复电子杂志,2017,(02):103.[doi:10.3877/cma.j.issn.2096-0263.2017.02.007]
　Yao Guojun,Yin Shumei,Zhao qinghai,et al.Comparative study of proximal fibula osteotomy and arthroscopic debridement in the treatment of knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):103.[doi:10.3877/cma.j.issn.2096-0263.2017.02.007]
[10]霍丽丽,颉朝阳,崔小雷.腓骨近端截骨联合膝关节镜下关节清理术治疗膝关节骨性关节炎的疗效分析[J].中华老年骨科与康复电子杂志,2017,(05):306.[doi:10.3877/cma.j.issn.2096-0263.2017.05.011]
　Huo Lili,Xie Chaoyang,Cui Xiaolei.Proximal tibia and fibula osteotomy combined with arthroscopic joint debridement in treatment of knee osteoarthritis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):306.[doi:10.3877/cma.j.issn.2096-0263.2017.05.011]

备注/Memo

备注/Memo:
基金项目：吉林大学研究生创新基金（2017043）
更新日期/Last Update: 2018-03-27