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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2024, Vol. 10 ›› Issue (05) : 301 -307. doi: 10.3877/cma.j.issn.2096-0263.2024.05.007

膝关节

膝骨关节炎患者前交叉韧带功能影像学影响因素分析
高广涵1, 张耀南2, 石磊2, 王林2, 王飞2, 郑子天2, 王鸿禹1, 郭民政1, 薛庆云2,†()   
  1. 1. 100730　北京医院/国家老年医学中心/北京协和医学院/中国医学科学院
    2. 100730　北京医院/国家老年医学中心/中国医学科学院
  • 收稿日期:2023-11-02 出版日期:2024-10-05
  • 通信作者: 薛庆云
  • 基金资助:
    中央高水平医院临床科研业务费

X-ray imaging analysis of anterior cruciate ligament function in patients with knee osteoarthritis

Guanghan Gao1, Yaonan Zhang2, Lei Shi2, Lin Wang2, Fei Wang2, Zitian Zheng2, Hongyu Wang1, Minzheng Guo1, Qingyun Xue2,†()   

  1. 1. Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    2. Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2023-11-02 Published:2024-10-05
  • Corresponding author: Qingyun Xue
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引用本文：

高广涵, 张耀南, 石磊, 王林, 王飞, 郑子天, 王鸿禹, 郭民政, 薛庆云. 膝骨关节炎患者前交叉韧带功能影像学影响因素分析[J]. 中华老年骨科与康复电子杂志, 2024, 10(05): 301-307.

Guanghan Gao, Yaonan Zhang, Lei Shi, Lin Wang, Fei Wang, Zitian Zheng, Hongyu Wang, Minzheng Guo, Qingyun Xue. X-ray imaging analysis of anterior cruciate ligament function in patients with knee osteoarthritis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(05): 301-307.

目的

探究在膝骨关节炎患者中，通过膝关节正、侧位X线片中的影像学信息判断前交叉韧带功能的方法。

方法

回顾性选取2021年10月至2023年12月，因膝骨关节炎入院治疗的患者156例，通过在手术中验证患者前交叉韧带功能并将其分为前交叉韧带有功能组和失功能组，对比两组患者在膝关节侧位片中胫骨平台磨损深度及最深位置、胫骨平台前后1/3位置磨损深度和正侧位片中膝关节骨赘分布情况，采用二元Logistic回归分析影像学变量对前交叉韧带功能判断的影响。

结果

共156例患者纳入本研究，男性59例（37.8%），女性97例（62.2%）。根据术中验证156例膝骨关节炎患者前交叉韧带功能结果，分为有功能组85例（54.5%），失功能组71例（45.5%）。有功能组磨损最深位置位于后方的占比为30.6%，失功能组磨损最深位置位于后方的占比为71.8%；有功能组D=1.7(1.3, 2.1) mm, d1=1.2(0.8，1.6) mm，d2=0.8(0.5，1.1) mm，失功能组D=2.3(1.8, 2.8) mm, d1=1.5(1.1, 2.1) mm, d2=1.8(1.0, 2.3) mm；有功能组胫骨平台及髁间有骨赘的占比分别为45.9%和38.8%，失功能组相应占比分别为73.2%和83.1%。有功能组K-L分级为Ⅳ级的占比为30.6%，失功能组K-L分级为Ⅳ级的占比为62.0%。磨损最深位置位于胫骨平台前方以及髁间没有骨赘是判断前交叉韧带功能的保护因素，而胫骨平台后1/3处磨损深度则为影响前交叉韧带功能的危险因素。

结论

前交叉韧带失功能的患者在膝关节侧位X线上表现为内侧胫骨平台磨损加重，且以后方磨损为著，并多伴有胫骨平台骨赘的增生，正位片多见髁间骨赘的增生。胫骨平台磨损最深位置、后1/3处磨损情况以及髁间骨赘增生情况可帮助医生准确判断ACL功能。

关键词: 膝骨关节炎, 前交叉韧带, X线
Objective

To evaluate the function of anterior cruciate ligament (ACL) more accurately in patients with knee osteoarthritis through the imaging information of anteroposterior and lateral knee X-ray.

Methods

156 patients admitted to hospital with knee osteoarthritis from October 2021 to December 2023 were retrospectively selected. ACL function was verified during surgery and the patients were divided into functional and non-functional ACL groups. The wear depth and deepest position of the tibial plateau, the wear depth of anterior and posterior the tibial plateau in 1/3 position, and the distribution of knee osteophytic features in the anteroposterior and lateral knee X-ray of the two groups were compared, and the influence of imaging variables on the judgment of ACL function was analyzed by binary Logistic regression.

Results

A total of 156 patients were included in this study, with 59 males (37.8%) and 97 females (62.2%). According to the results of ACL function verification in 156 patients with knee osteoarthritis, they were divided into functional group (85 cases) and non-functional group (71 cases). In the functional group, the deepest wear position in the posterior was 30.6%, and in the non-functional group, the deepest wear position in the posterior was 71.8%. D=1.7(1.3, 2.1)mm, d1=1.2(0.8, 1.6)mm and d2=0.8(0.5, 1.1)mm in functional group, D=2.3(1.8, 2.8)mm, d1=1.5(1.1, 2.1)mm and d2=1.8(1.0, 2.3)mm in non-functional group; The proportions of osteophytes in tibial plateau and intercondylar fossa were 45.9% and 38.8% in functional group, 73.2% and 83.1% in non-functional group, respectively. The proportion of the functional group with K-L grade Ⅳ was 30.6%, and the proportion of the non-functional group with K-L grade Ⅳ was 62.0% The deepest wear in front of the tibial plateau and the absence of osteophyte between the condyles are protective factors for judging ACL function, while the wear depth in the posterior 1/3 of the tibial plateau is a risk factor for affecting ACL function.

Conclusion

The patients with ACL dysfunction showed increased wear of the medial tibial plateau on X-ray, and the wear was mainly posterior, accompanied by the proliferation of osteophyte in tibial plateau and intercondylar fossa. The location of the deepest wear of the tibial plateau, the wear in the posterior 1/3 of the tibial plateau, and the intercondylar osteophyte proliferation can help accurately judge ACL function.

Key words: Osteoarthritis, Knee, Anterior cruciate ligament, X-ray
图1~2　膝骨关节炎膝关节侧位片。图1　患者女性，68岁，膝骨关节炎标准侧位片，股骨内外侧髁高度重叠；图2　患者女性，71岁，膝骨关节炎侧位片，股骨内外侧髁重叠不佳被排除　 图3　磨损深度测量黑线为磨损前胫骨平台关节线，蓝色为磨损后胫骨平台关节线　　 图4~5　膝关节置换术中验证ACL功能。图4　患者女性，69岁，膝骨关节炎UKA术中发现ACL连续，张力尚可，有功能；图5　患者女性，70岁膝骨关节炎TKA术中发现ACL大部分断裂或消失，失功能
表1 156例膝骨关节炎患者的一般资料
组别 例数 年龄（岁，±s） 性别（例） 侧别（例） BMI（kg·m-2，±s）
男 女 左 右
ACL有功能组 85 68.0±7.0 38 47 43 42 27.3±3.8
ACL失功能组 71 72.4±7.0 21 50 32 39 26.4±3.1
统计值   t=-3.964 χ2=3.765 χ2=0.472 t=1.577
P值   <0.001 0.052 0.492 0.117
表2 156例膝骨关节炎患者的影像学测量
组别 例数 磨损最深位置（例） D[mm，M（P25，P75）] d1[mm，M（P25，P75）] d2[mm，M（P25，P75）]
前 后
ACL有功能组 85 59 26 1.7（1.3，2.1） 1.2（0.8，1.6） 0.8（0.5，1.1）
ACL失功能组 71 20 51 2.3（1.8，2.8） 1.5（1.1，2.1） 1.8（1.0，2.3）
统计值   χ2=26.326 Z=-4.988 Z=-3.490 Z=-6.665
P值   <0.001 <0.001 <0.001 <0.001
组别 例数 胫骨平台骨赘（例） 股骨后方骨赘（例） 髁间骨赘（例） K-L分级（例）
有 无 有 无 有 无 Ⅲ Ⅳ
ACL有功能组 85 39 46 46 39 33 52 59 26
ACL失功能组 71 52 18 47 24 59 12 27 44
统计值   χ2=5.322 χ2=2.345 χ2=31.344 χ2=15.403
P值   0.021 0.126 <0.001 <0.001
表3 156例膝骨关节炎患者ACL功能有无的影像学因素Logistic回归分析
因素 β SE Wald OR 95% CI P值
磨损最深位置 -1.234 0.560 4.861 0.291 0.091，0.872 0.027
D -0.908 0.699 1.689 0.403 0.103，1.587 0.194
d1 1.212 0.622 3.795 3.361 0.993，11.378 0.051
d2 1.657 0.549 9.106 5.244 1.787，15.384 0.003
胫骨平台骨赘 -0.080 0.513 0.024 0.923 0.338，2.523 0.876
髁间骨赘 -1.463 0.559 6.852 0.231 0.077，0.692 0.009
K-L分级 -0.154 0.523 0.086 0.857 0.307，2.392 0.769
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