冠状位膝外侧股胫偏移的影像测量与相关分析△

Image measurement and correlation analysis of coronal lateral femorotibial deviation of the knee

摘要:

[目的] 研究中国人群正常肢体存在冠状位膝外侧股胫偏移（lateral femorotibial deviation, LFTD） 的发生率与程度，分析其与其他影像学参数的相关性。[方法] 回顾性分析2020 年10 月—2023 年10 月本院华奕区域医学影像系统符合纳入标准的双下肢全长负重位X 线片，测量LFTD、胫骨近端内侧角（mechanical medial proximal tibial angle, mMPTA）、髋-膝-踝角（hip knee ankle angle, HKA）、机械轴偏离（mechanical axis deviation, MAD）、外侧股骨远端机械角（mechanical lateral distal femo-ral angle, mLDFA） 及关节线匹配角（joint line congruence angle, JLCA），评估该人群存在LFTD 的程度及比例，比较男女两性之间测量结果差异，评估LFTD 与其他影像学参数的相关性。[结果] 本研究共纳入了387 个正常单侧下肢全长的X 线片，其中男性123 例，女性264 例。总体LFTD 为（3.8±2.0） mm。本研究纳入387 例正常的膝关节，91 例（74.0%） 男性膝关节和170例（64.4%） 女性膝关节LFTD＞3 mm，即膝关节存在体质性冠状位自然对位外侧偏移现象，仅6 例男性膝关节与2 例女性膝关节LFTD 为负值。两性比较方面，男性组的年龄显著小于女性组[(53.3±19.4) 岁vs (59.6±15.3) 岁, P=0.001]，男性组LFTD 显著大于女性组[(4.2±1.9) mm vs (3.6±2.1) mm, P=0.005]，但是，男性JLCA 显著小于女性[(1.9±1.9)° vs (2.5±2.3)°, P=0.023]。两性之间HKA、mLDFA、mMPTA、MAD 的差异均无统计学意义（P＞0.05）。LFTD 与其他影像指标的两两相关分析表明，所有影像测量指标均与LFTD 相关，相关程度依次为mMPTA （r=-0.343, P 0.001），HKA （r=0.334, P＜0.001） 和MAD （r=0.323, P＜0.001）。其他影像学参数相关程度较低：mLDFA（r=0.123, P=0.016） 和JLCA（r=0.110, P=0.030）。[结论] 中国人群正常膝关节大部分存在一定程度的冠状位膝外侧股胫偏移，其偏移程度与mMPTA、HKA 及MAD 存在一定的相关性。

Abstract:

[Objective] To search the incidence and extent of lateral femorotibial deviation (LFTD) of the knee in normal lower limbs inChinese population, and analyze its correlation with other imaging parameters. [Methods] A retrospective study was conducted on the thefull length weight-bearing X-rays of both lower limbs taken in our hospital with Huayi Regional Medical imaging System from October2020 to October 2023. The LFTD, mechanical medial proximal tibial angle (mMPTA), hip knee ankle angle (HKA), mechanical axis devia-tion (MAD), mechanical lateral distal femoral angle (mLDFA) and joint line congruence angle (JLCA) were measured and compared be-tween the male and female genders. The incidence and extent of LFTD were assayed in this population, additionally, the correlation be-tween LFTD and other imaging parameters was analyzed. [Results] A total of 387 full-length X-rays of normal unilateral lower limbs wereincluded in the study, involving 123 males and 264 females. The overall LFTD was of (3.8±2.0) mm. According to Nayak's criteria, amongthe 387 normal knees included in this study, 91 (74.0%) male knees and 170 (64.4%) female knees had LFTD ＞3 mm, which meant theknee had constitutional coronal lateral alignment deviation, and only 6 male knees and 2 female knees had negative LFTD. In terms of gen-der comparison, the male was significantly yonger than the female [(53.3±19.4) years vs (59.6±15.3) years, P=0.001], the male had signifi-cantly greater LFTD than the female [(4.2±1.9) mm vs (3.6±2.1) mm, P=0.005], and the male proved significantly less JLCA than the female[(1.9±1.9)° vs (2.5±2.3)°, P=0.023]. However, there were no significant differences regarding to HKA, mLDFA, mMPTA and MAD betweenmen and women (P＞0.05). As results of pairwise correlation analysis between LFTD and other image parameters, all the other image mea-surements were correlated with LFTD, and the correlation extent was ranked as mMPTA (r=-0.343, P＜0.001). HKA (r=0.334, P＜0.001),and MAD (r=0.323, P＜0.001), mLDFA (r=0.123, P=0.016) and JLCA (r=0.110, P=0.030). [Conclusion] Most of the normal knee in Chi-nese population have some extent of lateral femorotibial deviation of the knee in coronal plane, which is correlated with mMPTA, HKA andMAD.cantly greater LFTD than the female [(4.2±1.9) mm vs (3.6±2.1) mm, P=0.005], and the male proved significantly less JLCA than the female[(1.9±1.9)° vs (2.5±2.3)°, P=0.023]. However, there were no significant differences regarding to HKA, mLDFA, mMPTA and MAD betweenmen and women (P＞0.05). As results of pairwise correlation analysis between LFTD and other image parameters, all the other image mea-surements were correlated with LFTD, and the correlation extent was ranked as mMPTA (r=-0.343, P＜0.001). HKA (r=0.334, P＜0.001),and MAD (r=0.323, P＜0.001), mLDFA (r=0.123, P=0.016) and JLCA (r=0.110, P=0.030). [Conclusion] Most of the normal knee in Chi-nese population have some extent of lateral femorotibial deviation of the knee in coronal plane, which is correlated with mMPTA, HKA andMAD.