腓骨头高度评价膝骨关节炎程度的意义△

Significance of fibular head height in evaluating extent of knee osteoarthritis

摘要:

[目的]探讨腓骨头高度（fibular head height, FHH）与膝关节骨关节炎（knee osteoarthritis, KOA）的发生与发展的相关性。[方法]本院 2015 年 6 月—2021 年 6 月收治的 116 例患者纳入本研究，获取照片间隔时长平均（31.0±2.9）个月，对两个时间点资料进行比较，行两个时间点资料比较，对 K-L 分级与其他指标进行两两相关分析，以 FHH 值为因变量与其他因素进行多元线性逐步回归分析，探讨 FHH 与膝骨关节炎的相关性。[结果]与初次测量比，末次测量时年龄 [(60.5±6.8) 岁, (63.1± 7.0) 岁, P＜0.001]、WOMAC 评分 [(34.0±6.2), (47.7±6.3), P 0.001]、膝关节 K-L 分级 [例, I/II/III/IV, (0/89/22/5), (0/0/22/94), P＜ 0.001]、FTA [(178.6±3.7)°, (181.8±5.3)°, P＜0.001]、JLCA [(2.8±1.1)°, (4.4±1.7)°, P 0.001] 均显著增加，HSS 评分 [(72.2±8.2), (56.5± 7.8), P 0.001]、膝伸屈 ROM [(109.7±7.8)°, (97.6±6.1)°, P 0.001]、MPTA [(86.5±1.8)°, (85.0±2.4)°, P＜0.001]、AMTP [(8.7±4.2) mm, (5.2±4.9) mm, P＜0.001]、FHH [(10.3±3.5) mm, (7.9±3.8) mm, P 0.001]、FHTPA [(7.5±2.2)°, (4.7±2.0)°, P＜0.001] 均显著减小。两两相关分析表明，K-L 分级与年龄、WOMAC 评分、FTA、MPTA、JLCA 呈显著正相关 （P＜0.05），K-L 分级与 HSS 评分、AM- TP、ROM、FHH、FHTPA 呈显著负相关 （P＜0.05）。多元逐步回归分析显示，FHH 与 JLCA、WOMAC 呈显著负相关 （P＜ 0.05），与 ROM、AMTP 呈显著正相关 （P＜0.05）。[结论] 本研究通过连续影像学测量直观证实了 KOA 患者病情进展与 FHH 有关，FHH 可以作为 KOA X 线测量及评价指标。

Abstract:

[Objective] To investigate the correlation between fibular head height (FHH) and the occurrence and development of knee osteoarthritis (KOA). [Methods] A total of 116 patients who visited our hospital from June 2015 to June 2021 were included in this study, with the average time interval of two X rays taken of (31.0±2.9) months. The data of the two time points were compared, and pairwise correlation analysis was conducted between K-L grading and other indicators. Using FHH value as dependent variable and other factors as independent variables, multiple linear stepwise regression analysis was performed to explore the correlation between FHH and severity of the knee osteoarthritis. [Results] The age [(60.5±6.8), (63.1±7.0), P＜0.001], WOMAC score [(34.0±6.2), (47.7±6.3), P＜0.001], K-L grade [I/ II/III/IV, (0/89/22/5), (0/0/22/94), P＜0.001], FTA [(178.6±3.7)°, (181.8±5.3)°, P＜0.001], JLCA [(2.8±1.1)°, (4.4±1.7)°, P＜0.001] were significantly increased, whereas the HSS score [(72.2±8.2), (56.5±7.8), P＜0.001], the knee flexion-extension ROM [(109.7±7.8)°, (97.6±6.1)°, P＜0.001], MPTA [(86.5±1.8)°, (85.0±2.4)°, P＜0.001], AMTP [(8.7±4.2) mm, (5.2±4.9) mm, P＜0.001], FHH [(10.3±3.5) mm, (7.9±3.8) mm, P＜0.001], FHTPA [(7.5±2.2)°, (4.7±2.0)°, P＜0.001] were significantly reduced at the last X ray check compared with those in initial X ray examination. Regarding to pairwise correlation analysis, the K-L grading was significantly positively correlated with age, WOMAC score, FTA, MPTA and JLCA (P＜0.05), while was significantly negatively correlated with HSS score, AMTP, ROM, FHH and FHTPA (P＜0.05). As results of multiple stepwise regression analysis, the FHH was significantly negatively correlated with JLCA and WOMAC (P＜0.05), while significantly positively correlated with ROM and AMTP (P＜0.05). [Conclusion] This study visually confirmed that the progression of KOA is related to FHH through continuous imaging measurements, proving that FHH might be influencing factor for the disease progression of KOA, and FHH can be used as an X-ray measurement and evaluation index for KOA.