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内翻畸形膝关节骨关节炎外侧间室软骨磨损的危险因素分析

Risk factors for lateral compartmental cartilage wear in varus knee osteoarthritis

摘要:

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.

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abstracts:

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.

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