中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (35): 5655-5660.doi: 10.3969/j.issn.2095-4344.1012

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

膝骨关节炎疼痛与髌骨关节紊乱影像学量化指标的关系

刘盛菲,江艳君,岑卓灏,凌 敏,张 填,陈悦轩,周 驰   

  1. 广州中医药大学,广东省广州市   510405
  • 出版日期:2018-12-18 发布日期:2018-12-18
  • 通讯作者: 凌敏,副教授,广州中医药大学,广东省广州市 510405
  • 作者简介:刘盛菲,女,1990年生,河南省洛阳市人,汉族,广州中医药大学在读硕士,主要从事运动医学方面的研究。
  • 基金资助:

    国家自然科学基金(81373655);广东省自然科学基金(2015A030310203);广东省创新训练计划(201610572043);广东省高水平大学建设项目(A1-AFD018171Z11057);广州中医药大学第一附属医院人才培优项目(2015QN01)

Correlation of imaging indexes of patellar axial disorder with pain of knee osteoarthritis

Liu Shengfei, Jiang Yanjun, Cen Zhuohao, Ling Min, Zhang Tian, Chen Yuexuan, Zhou Chi   

  1. Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Online:2018-12-18 Published:2018-12-18
  • Contact: Ling Min, Associate professor, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Liu Shengfei, Master candidate, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81373655; the Natural Science Foundation of Guangdong Province, No. 2015A030310203; the Innovation Training Program of Guangdong Province, No. 201610572043; the High-Level University Construction Project of Guangdong Province, No. A1-AFD018171Z11057; the Talent Training Project of the First Affiliated Hospital of Guangxi University of Chinese Medicine, No. 2015QN01

摘要:

文章快速阅读:



 
文题释义:
髌骨关节紊乱:髌骨关节紊乱是退行性膝关节炎的早期表现,由于髌骨力线异常(髌骨半脱位和髌骨倾斜)及其周围支持带的异常紧张,使髌骨关节失稳紊乱。作者通过对膝骨关节紊乱的各项影像学指标进行分析,得出影响膝关节疼痛的相关因素。
髌骨轴位片:在髌骨轴位片中,髌骨关节面情况、髌骨移位程度、外侧过度压力综合征的判断均可体现,其在髌股关节稳定性诊断方面具有重要意义。髌骨轴位片摄片方法各异,包括Merchant法(患者仰卧位屈膝45°置于检查台边缘,球管与水平面成30°角摄片)、Ficat法(仰卧位屈膝30°摄片)、Jaroschy法(仰卧位屈膝60°摄片)和Settegast法(俯卧位屈膝120°)摄片等。因为摄片屈膝 < 30°的技术要求相对过高,而屈曲角度超过45°又会使一些脱位不严重的髌骨回到原位从而产生假阴性现象,目前普遍认为膝关节轴位片的屈膝角度为30°-45°。文章所采用的髌骨轴位片摄片角度为30°,是较为普遍的摄片角度。
 
摘要
背景:膝骨关节炎所引起的患者疼痛在影像学上有所体现,髌骨轴位片影像学参数改变能为膝骨关节炎的临床疼痛症状做出合理评价。
目的:探讨髌骨轴位片影像学参数改变与膝骨关节炎患者疼痛部位的相关性,为临床诊治膝骨关节炎提供参考。
方法:选择2014年9月至2016年9月在广州中医药大学第一附属医院进行髌骨轴位片拍摄并符合研究纳入标准的膝骨关节炎患者共80例作为疼痛组,另选择健康志愿者30例作为健康组。2组均屈膝30°行髌骨轴位片拍摄,在PACS影像学图片计算机处理系统分别采集髌股指数、髌股协调角、外侧髌股角、髌股倾斜角、股骨滑车沟角5个影像学参数;将膝骨关节炎患者疼痛部位分为膝前区、膝后区、膝内侧和膝外侧4个区域。
结果与结论:①疼痛组患者的髌股指数、髌股协调角以及外侧髌股角均大于健康组,差异均有显著性意义     (P < 0.05);2组髌股倾斜角以及股骨滑车沟角比较,差异无显著性意义(P > 0.05);②二元Logistic回归分析中,膝骨关节炎疼痛和外侧髌股角存在相关性(P=0.01);③One Way-ANOVA LSD统计分析中,疼痛组患者髌股倾斜角在膝前区和膝后区差异有显著性意义(P=0.038),其他影像学参数与不同疼痛部位的两两比较分析差异无显著性意义(P均 > 0.05);④结果表明,与健康志愿者相比,膝骨关节炎疼痛患者存在髌股关节的紊乱,髌骨偏向外侧倾斜和偏移;外侧髌股角是导致膝骨关节炎疼痛的最主要因素,髌股倾斜角影响着膝前区和膝后区的疼痛。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID: 0000-0001-9621-1766(刘盛菲)

关键词: 髌骨轴位片, 髌股关节紊乱, 疼痛, 膝骨关节炎, 临床意义, 国家自然科学基金

Abstract:

BACKGROUND: Pain caused by knee osteoarthritis is reflected in imaging. Change of radiographic parameters of the tibial axis slice can provide a reasonable assessment for the clinical pain symptoms of knee osteoarthritis.

OBJECTIVE: To analyze the correlation between the change of the imaging indexes of patellar axial radiograph and pain area in the knee osteoarthritis, thus providing reference for the diagnosis and treatment of knee osteoarthritis.
METHODS:Available samples were collected from the First Affiliated Hospital of Guangzhou University of Chinese Medicine between September 2014 and September 2016, where totally 80 knee osteoarthritis patients were selected as pain group and 30 healthy volunteers were selected as control group. All the participants took patellar axial radiograph with knee at 30° through PACS imaging systems to collect five imaging indexes, including patella exponent, femur trochlea angle, congruence angle, lateral patellofemoral angle and tilt angle. Knee osteoarthritis patients in the pain group were divided into four common clinical pain areas which were anterior, posterior, medial and lateral area.
RESULTS AND CONCLUSION: (1) The patellofemoral pain index, congruence angle, and lateral patellofemoral angle in the pain group were significantly larger than those in the control group (P < 0.05). In the patellofemoral angle, patellofemoral subluxation and femoral trochlear angle parameters, there was no significant difference between two groups (P > 0.05). (2) Two logistic regression analysis showed that there was a correlation between knee osteoarthritis pain and lateral patellofemoral angle (P=0.01). (3) From one way-ANOVA LSD statistical analysis, the patellofemoral angle in patellofemoral anterior and posterior areas had significant difference (P=0.038), and there were no differences in the other imaging parameters between pain areas (P > 0.05). (4) In summary, compared with the health volunteers, in the patients with pain caused by knee osteoarthritis, patellofemoral joint disorder and patella angle affects the pain of anterior and posterior areas, which has a connection with the saphenous nerve, the branches of the sciatic nerve and peroneal nerve branch of conduction.

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Patella, Osteoarthritis, Knee, Pain, Tissue Engineering

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