髋关节发育不良继发骨关节炎患者中心边缘角与出现疼痛年龄的相关性研究

发布时间：2018-09-19 16:04

【摘要】：目的:关节形态异常与髋关节骨关节炎(Osteoarthritis,OA)的发病具有密切的关系,其中,髋关节发育不良是髋关节OA的一个重要危险因素。如果关节发育不良未经或未能良好的纠正,继发OA的患病率将明显高于其他致病因素。有学者指出,关节发育不良继发髋关节OA的发病年龄较原发性髋关节OA更年轻,而我们在实际临床工作中也注意到了这一点。我们希望证实这一现象,并试图发现髋关节发育不良患者的中心边缘角(center-edge angle,CEA)与继发OA出现疼痛年龄之间的关系。方法:病例选取于吉林大学第二医院骨科医院关节外科,2013年11月—2015年12月成年髋关节发育不良继发OA患者87例,其中女性75例,男性12例。髋关节发育不良的诊断按Wiberg[1]的描述,即在标准的髋关节正位X线片上,至少一侧髋关节的CEA25°。而继发髋关节OA的诊断要依据患者的疼痛病史,结合髋关节OA的影像学分级方法T?nnis分级[2,3]和Kellgren-Lawrence分级[4],并且排除其他继发来源。数据整理和分析:(1)按单双侧和性别统计患髋数量,将入选患者患髋的CEA和相对应的出现疼痛的年龄及就诊年龄做统计学描述。(2)将入选患者患髋的CEA与相对应的出现疼痛的年龄做相关性分析。(3)将所有入选患者分组,患髋CEA10°为A组,≥10°为B组,比较两组患者出现疼痛平均年龄有无统计学差异。(4)同一患者出现疼痛年龄比较,即以所有患者左侧为标准,分别统计左侧CEA小于右侧者、左侧CEA大于右侧者、左侧出现疼痛年龄小于右侧者、左侧出现疼痛年龄大于右侧者的例数,将患者例数做四格表的统计学分析,比较CEA小的一侧与CEA大的一侧出现疼痛年龄有无差异。结果:1.我们统计髋关节发育不良原位继发OA的髋关节共95髋,有疼痛症状患者共85髋,占OA患髋数的89.47%,平均出现疼痛的年龄是46.02±17.37岁。2.将有疼痛症状的85髋CEA与对应出现疼痛年龄做相关性分析,结果显示,r=0.13,p=0.23,差异无统计学意义。3.AB两组对比平均出现疼痛年龄结果显示,A组(n=50)平均疼痛年龄43.24±12.20,B组(n=35)平均疼痛年龄50.66±14.42,P=0.01,差异有统计学意义。4.以双侧患病的左侧髋关节为准,CEA小于右侧21人,CEA大于右侧26人,左侧先出现疼痛症状22人,左侧后出现疼痛症状25人,采用四格表x2检验,p=0.001,差异有显著统计学意义。结论:1.发育不良的髋关节CEA与继发OA的发病年龄并无相关性,髋关节CEA不能单独作为预测发病年龄的指标。2.CEA10°的髋关节疼痛年龄小于CEA≥10°的患者,即CEA10°的患者较≥10°的会先出现疼痛症状。3.双侧均继发OA的患者,CEA小的一侧先出现疼痛症状。
[Abstract]:Objective: there is a close relationship between abnormal joint morphology and hip osteoarthritis (Osteoarthritis,OA). Hip dysplasia is an important risk factor of hip OA. If joint dysplasia is not well corrected, the prevalence of secondary OA is significantly higher than that of other risk factors. Some scholars have pointed out that the onset age of secondary hip OA is younger than that of primary hip OA, and we have noticed this in clinical work. We hope to confirm this phenomenon and try to find a relationship between the central marginal angle (center-edge angle,CEA) and the age of secondary OA pain in patients with dysplasia of the hip. Methods: 87 adult patients with OA secondary to hip dysplasia from November 2013 to December 2015 were selected from Orthopaedic Hospital of Jilin University. Among them 75 cases were female and 12 cases were male. The diagnosis of hip dysplasia is described by Wiberg [1], that is, at least one side of the hip is CEA25 掳on the standard orthographic radiographs. The diagnosis of secondary hip joint OA should be based on the patient's history of pain, combined with the imaging grading of hip joint OA, T?nnis grade [2T3] and Kellgren-Lawrence grade [4], and other secondary sources should be excluded. Data collation and analysis: (1) according to unilateral and bilateral and gender statistics, (2) the correlation analysis between the CEA of the hip and the age of pain was made. (3) all the patients were divided into two groups: the age at which the pain occurred and the age at which the pain occurred. (3) all the patients were divided into two groups: (1) the age of pain in the hip and the age at which the pain occurred. (3) all the patients were divided into two groups. The hip CEA10 掳was group A and 鈮，

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