膝骨性关节炎超声测量与临床表现的相关性研究△

Correlation between ultrasonic measurements and clinical presentation of knee osteoarthritis

摘要:

[目的] 探讨膝骨性关节炎 （knee osteoarthritis, KOA） 内侧稳定结构超声形态与膝关节功能和稳定性的关系。[方法]2023 年 3 月—2024 年 3 月在本院住院的 202 例单侧 KOA 患者纳入本研究，收集患者的超声形态参数及临床数据。分析超声测量指标与 KOA 功能和稳定性的相关性。[结果]依据自我报告的膝关节不稳定性评分，将患者分为两组，其中，不稳组 140 例，占 69.3%；稳定组 62 例，占 30.7%。不稳组 WOMAC [(45.2±4.8) vs (29.8±3.8), P＜0.001]、VAS [(6.3±1.7) vs (4.4±1.5), P＜ 0.001]、JLCA [(5.4±1.3)° vs (2.9±1.1)°, P＜0.001]、内侧副韧带厚度 [(3.5±1.4) mm vs (2.9±1.3) mm, P＜0.001]、内侧半月板外凸 [(3.8± 1.4) mm vs (2.2±0.9) mm, P＜0.001] 显著大于稳定组，而前者 HSS 评分 [(65.3±5.1) vs (88.6±3.2), P＜0.001]、膝屈伸 ROM [(118.4±5.3)° vs (130.5±5.1)°, P＜0.001]、HKA 角 [(170.9±3.7)° vs (176.2±3.1)°, P＜0.001]、股内侧肌厚度 [(1.8±0.6) cm vs (2.4±0.5) cm, P＜0.001]、股内侧肌横截面积 [(9.1±2.2) cm² vs (11.3±2.4) cm² , P＜0.001] 小于后者。两者在 K-L 评级上未见统计学差异（P＞0.05）。两两相关分析表明：股内侧肌厚度和横截面积，与自报膝不稳评分、HSS 评分、HKA 角、膝伸屈 ROM 呈显著正相关（P＜0.05），与 WOMAC、 VAS、JLCA 呈显著负相关（P＜0.05）。相反，内侧副韧带厚度和内侧半月板外凸厚度，与自报膝不稳评分、HSS 评分、HKA 角、 膝伸屈 ROM 评分呈显著负相关（P＜0.05），而与 WOMAC、VAS、JLCA 呈显著正相关（P＜0.05）。上述超声指标与 K-L 评级之间无相关性。多元线性逐步回归表明：股内侧肌横截面积（B=-0.101，P＜0.05）、内侧副韧带厚度（B=0.112，P＜0.05）、内侧半月板外凸（B=0.132，P＜0.05）是影响膝关节功能的因素。[结论] 对于自报膝关节不稳患者，行超声检测膝关节内侧结构有临床指导意义。

Abstract:

[Objective] To investigate the relationship between the ultrasonic morphology of the medial stable structures of knee osteoarthritis (KOA) and the clinical presentations of the knee. [Methods] A total of 202 patients with unilateral knee KOA hospitalized in our hospital from March 2023 to March 2024 were included in this study. The ultrasound measurements and clinical data of the patients were collected. The correlation between ultrasonic measurements and the clinical presentations of KOA was analyzed. [Results] According to the self-reported knee instability score, the patients were divided into two groups. Of them, 140 patients were fall into the unstable group, accounting for 69.3%; while other 62 patients (30.7%) were in the stable group. The unstable group proved significantly greater than the stable group regarding to WOMAC [(45.2±4.8) vs (29.8±3.8), P＜0.001], VAS [(6.3±1.7) vs (4.4±1.5), P＜0.001], JLCA [(5.4±1.3)° vs (2.9±1.1)°, P＜ 0.001], the thickness of the medial collateral ligament [(3.5±1.4) mm vs (2.9±1.3) mm, P＜0.001], extrusion of medial meniscus [(3.8±1.4) mm vs (2.2±0.9) mm, P＜0.001], whereas the former was significantly less than the latter in terms of HSS score [(65.3±5.1) vs (88.6±3.2), P＜ 0.001], knee flexion-extension ROM [(118.4±5.3)° vs (130.5±5.13)°, P＜0.001], HKA angle [(170.9±3.7)° vs (176.2±3.1)°, P＜0.001], the muscle thickness [(1.8±0.6) cm vs (2.4±0.5) cm, P＜0.001] and the cross-sectional area of the medial vastus muscle [(9.1±2.2) cm² vs (11.3± 2.4) cm² , P＜0.001]. There was no significant difference in K-L rating between the two groups (P＞0.05). Paired correlation analysis showed that the thickness and cross-sectional area of the vastus medialis muscle were significantly positively correlated with self-reported knee instability score, HSS score, HKA angle and knee flexion-extension ROM (P＜0.05), while significantly negatively correlated with WOMAC,VAS and JLCA angle (P＜0.05). On the contrary, medial collateral ligament thickness and medial meniscus extusion were significantly negatively correlated with self-reported knee instability score, HSS score, HKA angle and knee ROM score (P＜0.05), but were significantly positively correlated with WOMAC, VAS and JLCA angle (P＜0.05). There was no correlation between the above ultrasound indicators and K-L rating. As results of multiple linear stepwise regression, the cross-sectional area of vastus medialis muscle (B=-0.101, P＜0.05), thickness of medial collateral ligament (B=0.112, P＜0.05) and medial meniscus extrusion (B=0.132, P＜0.05) were the factors affecting knee joint function. [Conclusion] For patients with self-reported knee instability, ultrasound detection of medial knee structure has clinical guiding significance.