本文選題：非負(fù)重位 + 膝內(nèi)翻��； 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究目的 采用膝關(guān)節(jié)負(fù)重位與非負(fù)重位X線下肢力學(xué)軸線測量相結(jié)合的方法,結(jié)合MR對膝關(guān)節(jié)退變程度進行評價,探討膝內(nèi)翻的早期診斷對于膝關(guān)節(jié)退行性骨關(guān)節(jié)病早期診療的臨床意義。 材料與方法 搜集2011年7月至2013年7月因膝關(guān)節(jié)退行性骨關(guān)節(jié)病臨床癥狀于本院就診患者,進行站立位雙下肢全長X線攝影及仰臥位患側(cè)膝關(guān)節(jié)正位X線攝影,分別測量患側(cè)膝關(guān)節(jié)負(fù)重位與非負(fù)重位脛股角。 本研究以Brouwer等[1]在膝關(guān)節(jié)X線片上的測量方法為基礎(chǔ)測量脛股角；脛股角182。為膝內(nèi)翻,182。-184。為正常,184。為膝外翻。 選取其中膝關(guān)節(jié)非負(fù)重位診斷膝內(nèi)翻陰性,且負(fù)重位診斷為膝內(nèi)翻陽性患者60例,為樣本組(非負(fù)重位膝內(nèi)翻假陰性組)。選取膝關(guān)節(jié)非負(fù)重位診斷膝內(nèi)翻陰性,且負(fù)重位診斷膝內(nèi)翻陰性患者60例,為對照組(膝內(nèi)翻真陰性組)。 其中樣本組男16例,女44例,年齡40-70歲；左膝31例,右膝29例。對照組男37例,女23例；年齡40-70歲；左膝28例,右膝32例。 兩組患者既往均無膝關(guān)節(jié)手術(shù)史,無下肢骨折、炎癥、腫瘤、代謝性骨病或先天性疾病。 對選取出的樣本組及對照組患者均行膝關(guān)節(jié)MR檢查評價膝關(guān)節(jié)退行性骨關(guān)節(jié)病的發(fā)生。 1.樣本組與對照組病例,共120例,比較兩組患者負(fù)重位和非負(fù)重位測量脛股角的差異,兩組間均值比較采用配對t檢驗及Pearson相關(guān)分析。 2.分析非負(fù)重位假陰性膝內(nèi)翻的發(fā)生對于內(nèi)側(cè)半月板損傷發(fā)生和嚴(yán)重程度的影響,采用Mann-Whitney U檢驗。 3.分析非負(fù)重位假陰性膝內(nèi)翻的發(fā)生對于脛股內(nèi)側(cè)關(guān)節(jié)軟骨損傷發(fā)生和嚴(yán)重程度的影響,采用卡方檢驗。 4.分析非負(fù)重位假陰性膝內(nèi)翻的發(fā)生對于內(nèi)側(cè)副韌帶損傷發(fā)生和嚴(yán)重程度的影響,采用卡方檢驗。分析同一患者負(fù)重位與非負(fù)重位脛股角差的絕對值與內(nèi)側(cè)副韌帶損傷程度的相關(guān)性,采用Pearson相關(guān)分析。 結(jié)果 1、樣本組和對照組負(fù)重位脛股角(181.560±1.104)均小于非負(fù)重位脛股角(182.888+0.522),且二者呈正相關(guān)(r=0.482,P0.01),負(fù)重位測量對于膝內(nèi)翻的診斷更加敏感。 2、樣本組內(nèi)側(cè)半月板損傷發(fā)生率為：前角83.3%(50/60),體部75.0%(45/60),后角88.3%(53/60)。對照組內(nèi)側(cè)半月板損傷發(fā)生率為：前角21.7%(13/60),體部28.3%(17/60),后角33.3%(20/60),兩組退變發(fā)生率的差異具有統(tǒng)計學(xué)意義。樣本組內(nèi)側(cè)半月板前角(χ2=57.638,P=0.000)、體部(產(chǎn)59.244,P=0.000)、后角(χ2=48.884,P=0.000)的發(fā)生率和嚴(yán)重程度高于對照組。 3、樣本組脛股內(nèi)側(cè)關(guān)節(jié)軟骨退變的發(fā)生率為96.7%(58/60)；對照組脛股內(nèi)側(cè)關(guān)節(jié)軟骨退變的發(fā)生率為61.7%(37/60)。兩組脛股內(nèi)側(cè)關(guān)節(jié)軟骨退變發(fā)生率的差異具有統(tǒng)計學(xué)意義(χ2＝77.054,P=0.000)。樣本組脛股內(nèi)側(cè)關(guān)節(jié)軟骨損傷的發(fā)生率和嚴(yán)重程度高于對照組。 4、樣本組脛側(cè)副韌帶退變的發(fā)生率為66.7%(40/60)；對照組脛側(cè)副韌帶退變的發(fā)生率為18.3%(11/60)。兩組脛側(cè)副韌帶退變發(fā)生率的差異具統(tǒng)計學(xué)意義(χ2=33.004,P=0.000)。樣本組脛側(cè)側(cè)副韌帶退變的發(fā)生率和嚴(yán)重程度高于對照組。樣本組同一患者負(fù)重位與非負(fù)重位脛股角差的絕對值與脛側(cè)副韌帶損傷程度呈正相關(guān)(r=0.368,P=0.000)。 結(jié)論采取膝關(guān)節(jié)負(fù)重位與非負(fù)重位X線攝影相結(jié)合測量下肢力線的方法,早期診斷膝內(nèi)翻,對膝關(guān)節(jié)骨關(guān)節(jié)炎的早期診斷和治療有重要臨床意義。
[Abstract]:Purpose of study

To evaluate the clinical significance of early diagnosis and treatment of knee degenerative joint disease by combining the method of combining the weight of the knee joint with the non - negative - weight X - ray for the measurement of the degree of degeneration of the knee joint .

Materials and Methods

From July 2011 to July 2013 , the clinical symptoms of knee degenerative joint disease were collected in our hospital . The full - length X - ray photography and the supine position X - ray photography of the knee joint in the supine position were performed to measure the negative and non - negative tibial femoral angles of the knee joint .

In this study , Brouwer et al . , et al . , was used to measure the tibial femoral angle on the basis of the measurement method of X - ray on knee joint .
The tibiofemoral angle 182 . is in the knee , 182 . -184 . is normal , 184 . The knee is turned over .

Among them , 60 cases were diagnosed with non - negative weight of knee joint , 60 cases were negative in the knee , 60 cases were negative in the knee , and 60 cases were negative in the negative position , which was the control group ( the negative group in the knee ) .

Among them , there were 16 males and 44 females , aged 40 - 70 years .
There were 31 cases of left knee and 29 cases of right knee . There were 37 males and 23 females in the control group .
Age 40 - 70 years ;
The left knee was 28 cases and the right knee was 32 cases .

Both groups had no history of knee surgery , no lower limb fractures , inflammation , tumors , metabolic bone diseases , or congenital disorders .

Knee joint MR examination was performed on the selected sample group and control group to evaluate the occurrence of knee degenerative joint disease .

1 . There were 120 cases in the sample group and the control group , and the difference between the two groups was compared between the two groups . The paired t test and Pearson correlation analysis were used to compare the mean values between the two groups .

2 . To analyze the effect of the occurrence and severity of medial meniscus injury caused by the occurrence and severity of medial meniscus injury . Mann - Whitney U test was used .

3 . To analyze the effect of non - negative pressure on the occurrence and severity of articular cartilage injury in the medial tibial femoral joint , and the Chi - square test was adopted .

4 . To analyze the effect of the occurrence and severity of medial collateral ligament injury caused by the occurrence and severity of medial collateral ligament injury . The correlation between the absolute value of negative and non - negative tibial femoral angle in the same patient and the degree of medial collateral ligament injury were analyzed . Pearson correlation analysis was adopted .

Results

1 . The tibial femoral angle ( 181.560 鹵 1.104 ) in both the sample group and the control group was smaller than that of the non - negative tibial femoral angle ( 182.888 + 0.522 ) , and positive correlation was found between them ( r = 0.482 , P0.01 ) .

2 . The incidence of meniscus injury in the medial meniscus of the control group was 83.3 % ( 50 / 60 ) , 75.0 % ( 45 / 60 ) and 88.3 % ( 53 / 60 ) in the control group . The incidence and severity of medial meniscus injury in the control group were statistically significant ( 蠂2 = 57.638 , P = 0.000 ) . The incidence and severity of the posterior horn ( 蠂 2 = 48.884 , P = 0.000 ) were higher than that in the control group .

3 . The incidence of articular cartilage degeneration in the medial tibial muscle of the sample group was 96.7 % ( 58 / 60 ) .
In the control group , the incidence of articular cartilage degeneration was 61.7 % ( 37 / 60 ) . There was a significant difference in the incidence of cartilage degeneration between the two groups ( 蠂2 = 77.54 , P = 0.000 ) . The incidence and severity of articular cartilage injury were higher in the tibial and femoral joints than in the control group .

4 . The incidence of tibial collateral ligament degeneration in the sample group was 66.7 % ( 40 / 60 ) .
The incidence of degeneration of the tibial collateral ligament in the control group was 18.3 % ( 11 / 60 ) . The incidence of degeneration of tibial collateral ligament was significantly different between the two groups ( 蠂2 = 33.004 , P = 0.000 ) . The incidence and severity of tibial collateral ligament degeneration were higher in the sample group than in the control group ( r = 0.368 , P = 0.000 ) .

Conclusion Combined with non - negative and non - negative X - ray photography , the method of measuring lower limb force line is adopted , and the early diagnosis and treatment of knee osteoarthritis are of important clinical significance .
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.2;R682.6

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