晚期大骨节病型膝关节炎患者CT参数分析

An analysis of CT parameters in patients with advanced Kashin-Beck disease knee arthritis

摘要:

目的 分析晚期大骨节病型膝关节炎患者CT参数特点，为晚期大骨节病膝关节炎的诊断及膝关节置换术前设计提供参考。方法 回顾性分析重庆市人民医院创伤骨科2018年1月至2022年12月确诊的大骨节病膝关节炎患者，选择同期就诊的晚期膝关节骨性关节炎作为对照。用Mimics软件分析患者膝关节CT数据，测算膝关节骨赘体积、关节腔游离体数量、股骨髁内外侧横径（femoral mediolateral，FML）、股骨内侧髁前后径（femoral medial anteroposterior，FMAP）、股骨外侧髁前后径（femoral lateral anteroposterior，FLAP）、胫骨髁横径（tibial mediolateral，TML）、胫骨髁前后径（tibial anteroposterior，TAP）、胫骨内侧平台前后径（tibial medial anteroposterior，TMAP）、胫骨外侧平台前后径（tibial lateral anteroposterior，TLAP），并计算FML/FMAP、FML/FLAP、TML/TAP、TMAP/TLAP的比值。结果 共纳入70例患者，其中大骨节病组32例，骨关节炎组38例，2组患者在性别分布、平均年龄、体重指数上差异无统计学意义（P>0.05）。大骨节病组膝关节常形成多间室关节炎、关节周围有大量的骨赘形成、软骨下骨硬化。大骨节病组骨赘体积及关节腔内游离体数量更多（P<0.05），并且FML/FLAP、TMAP/TLAP大于对照组（P<0.05）。结论 晚期大骨节病膝关节炎患者退变征象更为明显，且股骨外侧髁、胫骨外侧平台前后径相对偏小，该影像学特点可为膝关节置换术前设计提供参考。

Abstract:

Objective To analyze the characteristics of computed tomography（CT） parameters in patients with advanced Kashin-Beck disease（KBD） knee arthritis and to provide a reference for the diagnosis of this disease and the preoperative planning of knee arthroplasty.Methods Patients diagnosed with KBD knee arthritis in our hospital from January 2018 to December 2022 were retrospectively analyzed，and the patients with advanced knee osteoarthritis in the same period were selected as controls. The CT parameters of patients’ knee joint were analyzed by Mimics software for measurement of knee-joint osteophyte volume，the number of loose bodies within the articular cavity，femoral mediolateral（FML） diameter，femoral medial anteroposterior（FMAP） diameter，femoral lateral anteroposterior（FLAP） diameter，tibial mediolateral（TML） diameter，tibial anteroposterior（TAP） diameter，tibial medial anteroposterior（TMAP） diameter，and tibial lateral anteroposterior（TLAP） diameter，and the FML/FMAP，FML/FLAP，TML/TAP，and TMAP/TLAP ratios were calculated.Results A total of 70 patients were included，with 32 patients in the KBD group and 38 patients in the osteoarthritis group. There were no significant differences in sex distribution，average age，and body mass index between the two groups （P>0.05）. In the KBD group，patients often developed multi-compartment arthritis in the knee joint with a large number of osteophytes around the joint，and significant subchondral osteosclerosis. The KBD group had significantly higher volume of osteophyte，number of loose bodies within the articular cavity，and FML/FLAP and TMAP/TLAP ratios than the control group（P<0.05）.Conclusion Patients with advanced KBD knee arthritis have more significant degenerative signs and smaller FLAP and TLAP diameters. These imaging characteristics can be useful for the preoperative planning of knee arthroplasty in patients with advanced KBD knee arthritis.