CAJ | 학술논문

目的研究内翻畸形膝关节骨关节炎外侧间室软骨磨损病变特点,分析外侧间室软骨磨损的危险因素.方法前瞻性选取中日友好医院骨关节外科2013年1月至12月行全膝关节置换术治疗的内翻膝骨关节炎患者,收集患者临床资料,记录术中外侧间室软骨状态,截骨标本进行病理学分析,分析外侧间室软骨磨损特点.根据调查资料,先进行单因素分析,有统计意义的变量进行多因素分析,分析外侧间室软骨磨损的危险因素.结果纳入研究患者共223例(286膝),男性37例(47膝),女性186例(239膝);年龄50～ 86岁,平均(66±8)岁;体重指数18.0 ～40.0 kg/m2,平均(27±5)kg/m2.患者术前双下肢负重全长正位X线片示膝关节内翻1°～34°,平均(8±4)°.关节活动度0°～143°,平均(103 ±21)°.膝关节美国特种外科医院(HSS)评分29 ～ 76分,平均(53±12)分.60例(75膝)发生外侧间室磨损,外侧间室软骨磨损比例占26.2％.单因素分析,外侧间室磨损与年龄、性别、左右侧、关节活动度、HSS评分无关(P＞0.05),而与病程、内翻角度、劳动强度、外侧半月板完整性、前交叉韧带完整性、外侧副韧带稳定性、影像学分级、内侧间室软骨Weidow分级有关(P＜0.05).Logistic多因素回归分析结果显示,劳动强度(OR=2.843,95％ CI:1.010 ～8.002)、病程(OR=1.216,95％ CI:1.115 ～1.325)是中老年膝关节外侧间室软骨磨损的危险因素,外侧半月板完整(OR=0.012,95％ CI:0.003～0.048)、前交叉韧带完整(OR=0.406,95％ CI:0.192 ～0.857)是膝关节外侧间室软骨的保护性因素.结论仅有小部分内翻膝骨关节炎患者存在外侧间室软骨磨损,其中,重劳动强度、病程长是外侧间室软骨磨损的危险因素,而外侧半月板、前交叉韧带完整是保护因素.
목적 연구내번기형슬관절골관절염외측간실연골마손병변특점,분석외측간실연골마손적위험인소.방법 전첨성선취중일우호의원골관절외과2013년1월지12월행전슬관절치환술치료적내번슬골관절염환자,수집환자림상자료,기록술중외측간실연골상태,절골표본진행병이학분석,분석외측간실연골마손특점.근거조사자료,선진행단인소분석,유통계의의적변량진행다인소분석,분석외측간실연골마손적위험인소.결과 납입연구환자공223례(286슬),남성37례(47슬),녀성186례(239슬);년령50～ 86세,평균(66±8)세;체중지수18.0 ～40.0 kg/m2,평균(27±5)kg/m2.환자술전쌍하지부중전장정위X선편시슬관절내번1°～34°,평균(8±4)°.관절활동도0°～143°,평균(103 ±21)°.슬관절미국특충외과의원(HSS)평분29 ～ 76분,평균(53±12)분.60례(75슬)발생외측간실마손,외측간실연골마손비례점26.2％.단인소분석,외측간실마손여년령、성별、좌우측、관절활동도、HSS평분무관(P＞0.05),이여병정、내번각도、노동강도、외측반월판완정성、전교차인대완정성、외측부인대은정성、영상학분급、내측간실연골Weidow분급유관(P＜0.05).Logistic다인소회귀분석결과현시,노동강도(OR=2.843,95％ CI:1.010 ～8.002)、병정(OR=1.216,95％ CI:1.115 ～1.325)시중노년슬관절외측간실연골마손적위험인소,외측반월판완정(OR=0.012,95％ CI:0.003～0.048)、전교차인대완정(OR=0.406,95％ CI:0.192 ～0.857)시슬관절외측간실연골적보호성인소.결론 부유소부분내번슬골관절염환자존재외측간실연골마손,기중,중노동강도、병정장시외측간실연골마손적위험인소,이외측반월판、전교차인대완정시보호인소.
Objective To analyze the gross features of articular cartilage wear in varus knee osteoarthritis,and discuss the risk factors for lateral compartmental cartilage erosion.Methods Data prospectively collected from the dissection of 286 total knee arthroplasties (223 patients)with varus knee osteoarthritis from January 2013 to December 2013 were analyzed.At the operation,the gross assessments of articular cartilage,ligament and meniscus were recorded,and then the slices were evaluated for histologic analysis.Parameters of the patients with lateral compartmental cartilage erosion were compared with those without lateral compartmental cartilage erosion using the univariate analysis.Logistic regression analysis was used to analyze the risk factors associated with lateral compartmental cartilage erosion.Results There were 223 patients with 286 knees were included,including 37 male patients (47 knees) and 189 female patients (239 knees),with an average age of (66 ± 8)years (range 50-86 years),body mass index (BMI)was (27 ± 5) kg/m2 (18.0-40.0 kg/m2).Varus degree was 8° ± 4° (1 °-34°).Range of motion was 103° ±21°(0°-143°),and Hospital for Special Surgery (HSS) score was 53 ± 12 (29-76).Seventy-five knees (60 patients) showed lateral compartmental cartilage wear (26.2％).Environmental factors showed no differences in age,side,gender,BMI,range of motion,and HSS score (P ＞ 0.05).Factors significantly increasing the risk of lateral compartmental cartilage wear by univariate analysis included varus degree,activity level,duration of onset,meniscus,Weidow grade,Kellgren-Lawrence grade,collateral ligament and anterior cruciate ligament(P ＜0.05).Multiple Logistic regression analysis revealed the factors most highly associated with the increase risk for lateral compartmental wear were high activity level (OR =2.843,95％ CI:1.010-8.002) and longer duration of onset (OR =1.216,95％ CI:1.115-1.325).However,intact lateral meniscus (OR =0.012,95 ％ CI:0.003-0.048) and anterior cruciate ligament (OR =0.406,95％ CI:0.192-0.857) were associated with the protection of lateral compartmental.Conclusions In varus knee osteoarthritis,the wear incidence of lateral compartmental is low.High activity and increased duration of onset are risk factors of lateral compartmental wear,and intact meniscus and anterior cruciate ligament are protective factors.