负重位与非负重位X线结合早期诊断膝内翻的临床意义

发布时间：2018-06-03 22:09

本文选题：非负重位 + 膝内翻　；参考：《天津医科大学》2014年硕士论文

【摘要】：研究目的采用膝关节负重位与非负重位X线下肢力学轴线测量相结合的方法,结合MR对膝关节退变程度进行评价,探讨膝内翻的早期诊断对于膝关节退行性骨关节病早期诊疗的临床意义。材料与方法搜集2011年7月至2013年7月因膝关节退行性骨关节病临床症状于本院就诊患者,进行站立位双下肢全长X线摄影及仰卧位患侧膝关节正位X线摄影,分别测量患侧膝关节负重位与非负重位胫股角。本研究以Brouwer等[1]在膝关节X线片上的测量方法为基础测量胫股角；胫股角182。为膝内翻,182。-184。为正常,184。为膝外翻。选取其中膝关节非负重位诊断膝内翻阴性,且负重位诊断为膝内翻阳性患者60例,为样本组(非负重位膝内翻假阴性组)。选取膝关节非负重位诊断膝内翻阴性,且负重位诊断膝内翻阴性患者60例,为对照组(膝内翻真阴性组)。其中样本组男16例,女44例,年龄40-70岁；左膝31例,右膝29例。对照组男37例,女23例；年龄40-70岁；左膝28例,右膝32例。两组患者既往均无膝关节手术史,无下肢骨折、炎症、肿瘤、代谢性骨病或先天性疾病。对选取出的样本组及对照组患者均行膝关节MR检查评价膝关节退行性骨关节病的发生。 1.样本组与对照组病例,共120例,比较两组患者负重位和非负重位测量胫股角的差异,两组间均值比较采用配对t检验及Pearson相关分析。 2.分析非负重位假阴性膝内翻的发生对于内侧半月板损伤发生和严重程度的影响,采用Mann-Whitney U检验。 3.分析非负重位假阴性膝内翻的发生对于胫股内侧关节软骨损伤发生和严重程度的影响,采用卡方检验。 4.分析非负重位假阴性膝内翻的发生对于内侧副韧带损伤发生和严重程度的影响,采用卡方检验。分析同一患者负重位与非负重位胫股角差的绝对值与内侧副韧带损伤程度的相关性,采用Pearson相关分析。结果 1、样本组和对照组负重位胫股角(181.560±1.104)均小于非负重位胫股角(182.888+0.522),且二者呈正相关(r=0.482,P0.01),负重位测量对于膝内翻的诊断更加敏感。 2、样本组内侧半月板损伤发生率为：前角83.3%(50/60),体部75.0%(45/60),后角88.3%(53/60)。对照组内侧半月板损伤发生率为：前角21.7%(13/60),体部28.3%(17/60),后角33.3%(20/60),两组退变发生率的差异具有统计学意义。样本组内侧半月板前角(χ2=57.638,P=0.000)、体部(产59.244,P=0.000)、后角(χ2=48.884,P=0.000)的发生率和严重程度高于对照组。 3、样本组胫股内侧关节软骨退变的发生率为96.7%(58/60)；对照组胫股内侧关节软骨退变的发生率为61.7%(37/60)。两组胫股内侧关节软骨退变发生率的差异具有统计学意义(χ2＝77.054,P=0.000)。样本组胫股内侧关节软骨损伤的发生率和严重程度高于对照组。 4、样本组胫侧副韧带退变的发生率为66.7%(40/60)；对照组胫侧副韧带退变的发生率为18.3%(11/60)。两组胫侧副韧带退变发生率的差异具统计学意义(χ2=33.004,P=0.000)。样本组胫侧侧副韧带退变的发生率和严重程度高于对照组。样本组同一患者负重位与非负重位胫股角差的绝对值与胫侧副韧带损伤程度呈正相关(r=0.368,P=0.000)。结论采取膝关节负重位与非负重位X线摄影相结合测量下肢力线的方法,早期诊断膝内翻,对膝关节骨关节炎的早期诊断和治疗有重要临床意义。
[Abstract]:Purpose of study

To evaluate the clinical significance of early diagnosis and treatment of knee degenerative joint disease by combining the method of combining the weight of the knee joint with the non - negative - weight X - ray for the measurement of the degree of degeneration of the knee joint .

Materials and Methods

From July 2011 to July 2013 , the clinical symptoms of knee degenerative joint disease were collected in our hospital . The full - length X - ray photography and the supine position X - ray photography of the knee joint in the supine position were performed to measure the negative and non - negative tibial femoral angles of the knee joint .

In this study , Brouwer et al . , et al . , was used to measure the tibial femoral angle on the basis of the measurement method of X - ray on knee joint .
The tibiofemoral angle 182 . is in the knee , 182 . -184 . is normal , 184 . The knee is turned over .

Among them , 60 cases were diagnosed with non - negative weight of knee joint , 60 cases were negative in the knee , 60 cases were negative in the knee , and 60 cases were negative in the negative position , which was the control group ( the negative group in the knee ) .

Among them , there were 16 males and 44 females , aged 40 - 70 years .
There were 31 cases of left knee and 29 cases of right knee . There were 37 males and 23 females in the control group .
Age 40 - 70 years ;
The left knee was 28 cases and the right knee was 32 cases .

Both groups had no history of knee surgery , no lower limb fractures , inflammation , tumors , metabolic bone diseases , or congenital disorders .

Knee joint MR examination was performed on the selected sample group and control group to evaluate the occurrence of knee degenerative joint disease .

1 . There were 120 cases in the sample group and the control group , and the difference between the two groups was compared between the two groups . The paired t test and Pearson correlation analysis were used to compare the mean values between the two groups .

2 . To analyze the effect of the occurrence and severity of medial meniscus injury caused by the occurrence and severity of medial meniscus injury . Mann - Whitney U test was used .

3 . To analyze the effect of non - negative pressure on the occurrence and severity of articular cartilage injury in the medial tibial femoral joint , and the Chi - square test was adopted .

4 . To analyze the effect of the occurrence and severity of medial collateral ligament injury caused by the occurrence and severity of medial collateral ligament injury . The correlation between the absolute value of negative and non - negative tibial femoral angle in the same patient and the degree of medial collateral ligament injury were analyzed . Pearson correlation analysis was adopted .

Results

1 . The tibial femoral angle ( 181.560 卤 1.104 ) in both the sample group and the control group was smaller than that of the non - negative tibial femoral angle ( 182.888 + 0.522 ) , and positive correlation was found between them ( r = 0.482 , P0.01 ) .

2 . The incidence of meniscus injury in the medial meniscus of the control group was 83.3 % ( 50 / 60 ) , 75.0 % ( 45 / 60 ) and 88.3 % ( 53 / 60 ) in the control group . The incidence and severity of medial meniscus injury in the control group were statistically significant ( 蠂2 = 57.638 , P = 0.000 ) . The incidence and severity of the posterior horn ( 蠂 2 = 48.884 , P = 0.000 ) were higher than that in the control group .

3 . The incidence of articular cartilage degeneration in the medial tibial muscle of the sample group was 96.7 % ( 58 / 60 ) .
In the control group , the incidence of articular cartilage degeneration was 61.7 % ( 37 / 60 ) . There was a significant difference in the incidence of cartilage degeneration between the two groups ( 蠂2 = 77.54 , P = 0.000 ) . The incidence and severity of articular cartilage injury were higher in the tibial and femoral joints than in the control group .

4 . The incidence of tibial collateral ligament degeneration in the sample group was 66.7 % ( 40 / 60 ) .
The incidence of degeneration of the tibial collateral ligament in the control group was 18.3 % ( 11 / 60 ) . The incidence of degeneration of tibial collateral ligament was significantly different between the two groups ( 蠂2 = 33.004 , P = 0.000 ) . The incidence and severity of tibial collateral ligament degeneration were higher in the sample group than in the control group ( r = 0.368 , P = 0.000 ) .

Conclusion Combined with non - negative and non - negative X - ray photography , the method of measuring lower limb force line is adopted , and the early diagnosis and treatment of knee osteoarthritis are of important clinical significance .
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R682.6

【参考文献】