發(fā)布時(shí)間：2018-06-24 17:42

  本文選題：膝骨性關(guān)節(jié)炎 + 矢狀面平衡　； 參考：《南京醫(yī)科大學(xué)》2015年碩士論文

【摘要】：第一部分:膝關(guān)節(jié)骨關(guān)節(jié)炎患者脊柱-骨盆-下肢矢狀面形態(tài)變化的初步研究目的:通過比較膝關(guān)節(jié)骨性關(guān)節(jié)炎(knee osteoarthritis,KOA)患者與正常人的矢狀面相關(guān)參數(shù),探討KOA患者矢狀面形態(tài)異常及其臨床意義。方法:研究收集正常人58例、KOA患者75例的站立位全脊柱側(cè)位X線片并測(cè)量下列參數(shù):(1)脊柱矢狀面參數(shù):脊柱骶骨角(spinal-sacral angle,SSA)、脊柱前傾角(spinal tilt,ST/C7T)、腰椎前凸角(lumbar lordosis,LL);(2)骨盆及相關(guān)下肢矢狀面參數(shù):骨盆投射角(pelvic incidence,PI)、骶骨傾斜角(sacral slope,SS)、骨盆傾斜角(pelvic tilt,PT)、骶骨股骨角(sacrum femoral angle,SFA)、骨盆股骨角(pelvic femoral angle,PFA);股骨傾斜角(femoral inclination,FI)。采用獨(dú)立樣本t檢驗(yàn)分析組間各矢狀面參數(shù)間的差異性,同時(shí)應(yīng)用Pearson相關(guān)性分析KOA組各個(gè)參數(shù)相關(guān)性。結(jié)果:KOA組FI(11.1±4.9)較正常對(duì)照組(4.2±3.5)增大,但SFA(42.7±11.4)和PFA(2.0±8.7)值較正常對(duì)照組(SFA:51.8±8.5;PFA:9.1±8.1)減小,且差異均有統(tǒng)計(jì)學(xué)意義(p0.05);此外KOA組ST(88.9±4.3)值較正常對(duì)照組(92.9±3.5)減小,且差異有統(tǒng)計(jì)學(xué)意義(p0.05);而SS、PT和PI值與正常對(duì)照組相近,且差異無統(tǒng)計(jì)學(xué)意義(p0.05)。KOA組SFA與PFA存在明顯正相關(guān)(r=0.494),而與FI則存在明顯負(fù)相關(guān)(r=-0.668);PFA與FI存在明顯負(fù)相關(guān)(r=-0.586)。結(jié)論:KOA患者膝關(guān)節(jié)明顯屈曲,導(dǎo)致其脊柱和骨盆前傾。KOA患者的這些矢狀面形態(tài)在行全膝關(guān)節(jié)置換術(shù)設(shè)計(jì)時(shí)需要加以考慮。第二部分:膝關(guān)節(jié)骨關(guān)節(jié)炎患者脊柱-骨盆-下肢矢狀面形態(tài)變化與腰痛關(guān)系的初步研究目的:對(duì)KOA患者的脊柱-骨盆-下肢矢狀面形態(tài)進(jìn)行測(cè)量分析,并與正常人進(jìn)行比較,明確KOA患者的矢狀面形態(tài)、相關(guān)機(jī)制及臨床意義,并探究慢性腰痛繼發(fā)于KOA的可能機(jī)制。方法:研究收集正常人58例、KOA患者75例的站立位全脊柱側(cè)位X線片并測(cè)量下列參數(shù):(1)脊柱矢狀面參數(shù):脊柱骶骨角(spinal-sacral angle,SSA)、脊柱前傾角(spinal tilt,ST/C7T)、腰椎前凸角(lumbar lordosis,LL);(2)骨盆及相關(guān)下肢矢狀面參數(shù):骨盆投射角(pelvic incidence,PI)、骶骨傾斜角(sacral slope,SS)、骨盆傾斜角(pelvic tilt,PT)、骶骨股骨角(sacrum femoral angle,SFA)、骨盆股骨角(pelvic femoral angle,PFA);股骨傾斜角(femoral inclination,FI);腰痛評(píng)分(Visual analogue score,VAS)。采用獨(dú)立樣本t檢驗(yàn)分析組間各矢狀面參數(shù)間的差異性,同時(shí)應(yīng)用Pearson相關(guān)性分析KOA組各個(gè)參數(shù)相關(guān)性。根據(jù)C7鉛垂線到骨盆的相對(duì)位置,將脊柱-骨盆平衡分為三類。結(jié)果:KOA組FI(11.1±4.9)較正常對(duì)照組增大,但SFA(42.7±11.4)和PFA(2.0±8.7)值較正常對(duì)照組減小,且差異均有統(tǒng)計(jì)學(xué)意義(p0.05);此外KOA組ST(88.9±4.3)值較正常對(duì)照組減小,且差異有統(tǒng)計(jì)學(xué)意義(p0.05);FI≤10°的患者,相比對(duì)照組LL減小,FI和C7T明顯減小,但骨盆(PT,PI,SS)和髖關(guān)節(jié)屈曲(SFA,PFA)參數(shù)沒有差別。相反地,FI10°的患者,相比對(duì)照組FI和SS顯著增大,但C7T、SFA和PFA減小。比較KOA組的兩個(gè)子組之間的這些參數(shù)后,我們發(fā)現(xiàn),與FI≤10°組相比FI10°組C7T,SFA和PFA明顯減小,但FI卻明顯增大。另外,FI10°組LL較FI≤10°組明顯增大。與正常對(duì)照組相比KOA組有嚴(yán)重的脊柱-骨盆矢狀面失平衡,且FI10°組較FI≤10°組更易出現(xiàn)矢狀面的失平衡。結(jié)論:KOA患者膝關(guān)節(jié)明顯屈曲,導(dǎo)致其脊柱和骨盆前傾。FI≤10o的膝關(guān)節(jié)骨性關(guān)節(jié)炎患者腰椎將作為代償輕度膝關(guān)節(jié)屈曲,LL減小。然而,嚴(yán)重的患者膝關(guān)節(jié)屈曲(FI10°),脊柱、骨盆和髖關(guān)節(jié)都參與了矢狀面的代償,表現(xiàn)為脊柱前傾、骨盆前傾和髖關(guān)節(jié)屈曲。腰椎前凸的減小和脊柱前傾可加快慢性腰痛在這些患者的發(fā)展或惡化。第三部分:Crowe IV型DDH患者脊柱-骨盆-下肢矢狀面平衡狀態(tài)異常及其臨床意義目的:通過比較Crowe IV型髖關(guān)節(jié)發(fā)育不良患者(Developmental dysplasia of hip,DDH)與正常人和原發(fā)性髖骨性關(guān)節(jié)炎患者(hip osteoarthritis,HOA)的矢狀面相關(guān)參數(shù),探討DDH患者矢狀面形態(tài)異常及其臨床意義。方法:研究收集正常人40例、HOA患者30例和雙側(cè)Crowe IV型DDH患者16例的站立位全脊柱側(cè)位X線片并測(cè)量下列參數(shù):(1)骨盆矢狀面參數(shù):骨盆投射角(pelvic incidence,PI)、骶骨傾斜角(sacral slope,SS)、骨盆傾斜角(pelvic tilt,PT)、骶骨骨盆角(sacrum pubic incidence,SPI)、骶骨股骨角(sacrum femoral angle,SFA)、骨盆股骨角(pelvic femoral angle,PFA);(2)脊柱矢狀面參數(shù):脊柱前傾角(spinal tilt,ST)、腰椎前凸角(lumbar lordosis,LL);(3)下肢矢狀面參數(shù):股骨傾斜角(femoral inclination,FI)。采用ANOVA檢驗(yàn)分析各組間各矢狀面參數(shù)間的差異性,同時(shí)進(jìn)行各組間各個(gè)參數(shù)的可信度比較分析。結(jié)果:三組間年齡、性別分布差異無統(tǒng)計(jì)學(xué)意義。DDH組的PI可信度(a=0.008)較正常對(duì)照(a=0.350)及HOA組(a=0.276)低。DDH組SS(45.6±12.09)、PT(16.7±8.81)、PI(55.3±16.63)、PFA(12.7±15.15)、SPI(76.4±10.87)、FI(14.3±7.12)均較HOA組增大,且差異有統(tǒng)計(jì)學(xué)意義(P0.05);LL(37.3±15.87)、ST(87.8±5.43)均與HOA組相近,且差異無統(tǒng)計(jì)學(xué)意義,但與正常對(duì)照組相比差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:DDH患者較HOA患者骨盆更加前傾,導(dǎo)致其脊柱前傾,髖、膝關(guān)節(jié)屈曲。DDH患者的這些矢狀面形態(tài)在行全髖關(guān)節(jié)置換術(shù)設(shè)計(jì)時(shí)需要加以考慮。
[Abstract]:The first part: preliminary study on the morphological changes of the spinal - pelvis and lower extremity in patients with osteoarthritis of the knee. Objective: To investigate the abnormal sagittal morphology of the patients with knee osteoarthritis (KOA) and the normal human sagittal plane, and to explore the clinical significance of the abnormal sagittal plane in KOA patients. Methods: 58 cases of normal people were collected, KOA The following parameters of the standing total spinal lateral position were measured in 75 patients: (1) the parameters of the sagittal plane of the spine: spinal-sacral angle, SSA, spinal tilt, ST/C7T, lumbar lordosis, LL; (2) the pelvic and related lower extremity sagittal parameters: pelvic projection angle (pelvic incidence, PI) Acral slope, SS), pelvic inclination angle (pelvic tilt, PT), sacral femoral angle (sacrum femoral angle, SFA), pelvis femur angle (pelvic femoral), and femur inclination angle. Results: in group KOA, FI (11.1 + 4.9) was higher than that of normal control group (4.2 + 3.5), but SFA (42.7 + 11.4) and PFA (2 + 8.7) were lower than normal control group (SFA:51.8 + 8.5; PFA:9.1 + 8.1), and the difference was statistically significant (P0.05); moreover, the ST (88.9 + 4.3) value of KOA group was lower than that of normal control group (P0.05), and the difference was statistically significant (P0.05); S The values of S, PT and PI were similar to those of the normal control group, and the difference was not statistically significant (P0.05) there was a significant positive correlation between SFA and PFA in.KOA group (r=0.494), but there was a significant negative correlation with FI (r=-0.668); PFA was negatively correlated with FI. The second part: a preliminary study of the relationship between the morphological changes of the spine to the pelvis and the sagittal plane and the low back pain in patients with osteoarthritis of the knee: the measurement and analysis of the spinal - pelvis and lower extremities in KOA patients, and to compare with the normal people to make clear the sagittal of the KOA patients. Shape, mechanism and clinical significance, and to explore the possible mechanism of chronic low back pain secondary to KOA. Methods: To study 75 cases of normal people and 75 cases of standing total spinal lateral X ray and measure the following parameters: (1) spinal sagittal plane parameters: spinal-sacral angle (SSA), spinal tilt (ST/C7T), lumbar spine (ST/C7T), lumbar spine, and lumbar spine (spinal tilt, ST/C7T), waist Lumbar lordosis (LL); (2) pelvic and related lower limb sagittal parameters: pelvic projection angle (pelvic incidence, PI), sacral tilting angle (sacral slope, SS), pelvic inclination (pelvic tilt, PT), sacral femoral angle, pelvis femur angle; femur inclination angle; Visual analogue score (VAS). An independent sample t test was used to analyze the differences between the parameters of the sagittal plane between the groups, and the correlation of the parameters of the KOA group was analyzed with the Pearson correlation. The spinal pelvic balance was divided into three categories according to the relative position of the C7 plumb line to the pelvis. Results: the KOA group FI (11.1 + 4.9) was higher than that of the normal control group. But the values of SFA (42.7 + 11.4) and PFA (2 + 8.7) were smaller than those in the normal control group (P0.05), and the ST (88.9 + 4.3) values in the KOA group were lower than those in the normal control group, and the difference was statistically significant (P0.05). The LL decreased and the FI and C7T decreased significantly in the patients with FI < 10 degrees, but the pelvis (PT, PI, etc.) and the hip joint flexion. FA) parameters were not different. On the contrary, the patients with FI10 degrees were significantly larger than the control group FI and SS, but C7T, SFA and PFA decreased. After comparing the parameters between the two subgroups of the KOA group, we found that the FI10 degree group was significantly smaller than the FI < 10 degree group. Compared with the KOA group, the normal control group had severe spinal - pelvic sagittal imbalance, and the FI10 degree group was more prone to sagittal imbalance than that of the group of FI < 10 degrees. Conclusion: the knee joint was flexed obviously in KOA patients, and the lumbar vertebrae of the patients with the spine and pelvic forward.FI less than 10o of the knee osteoarthritis would be compensated for mild knee flexion, and LL decreased. In severe patients, the knee flexion (FI10), the spine, the pelvis and the hip joint are involved in the sagittal plane, showing the spine forward, the pelvis forward and hip flexion. The decrease of the lumbar lordosis and the spine forward can accelerate the development or degrading of the chronic low back pain in these patients. The third part: Crowe IV type DDH patients with the spine to the pelvis and lower sagittal sagittal Objective: To explore the abnormal sagittal surface of Crowe IV of hip (DDH) and normal people and patients with primary osteoarthritis (hip osteoarthritis, HOA), and to explore the abnormal sagittal morphology of DDH patients and their clinical significance. The following parameters were collected from 40 normal people, 30 HOA patients and 16 patients with bilateral Crowe IV DDH, and the following parameters were measured: (1) pelvic sagittal plane parameters: pelvic incidence, PI, sacral slope, SS, pelvic inclination (pelvic tilt), sacral pelvis angle, Sacrum femoral angle (SFA), pelvis femur angle (pelvic femoral angle, PFA); (2) spinal sagittal plane parameters: spinal anterior tilt angle (spinal tilt, ST), lumbar anterior convex angle (lumbar), and sagittal plane parameters of the lower extremities: femoral tilting angle. Results: the reliability of each parameter in each group was compared. Results: the age of the three groups, the gender distribution difference was not statistically significant in.DDH group PI reliability (a=0.008) more than normal control (a=0.350) and HOA group (a=0.276) low.DDH SS (45.6 + 12.09), PT (16.7 + 8.81), PI (55.3 + 16.63), PFA (12.7 + 15.15), SPI (76.4 + 10.87), 14.3 + (14.3 +). 7.12) more than the HOA group, and the difference was statistically significant (P0.05); LL (37.3 + 15.87), ST (87.8 + 5.43) were similar to HOA group, and there was no statistical significance, but the difference was statistically significant compared with the normal control group (P0.05). Conclusion: DDH patients were more forward than HOA patients, leading to their spinal tilt, hip, and knee flexion in.DDH patients. These sagittal shapes need to be considered in the design of total hip arthroplasty.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

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3 本報(bào)記者王波實(shí)習(xí)生李璞璞;領(lǐng)跑脊柱先進(jìn)治療技術(shù)[N];科技日?qǐng)?bào);2003年

4 北京積水潭醫(yī)院院長 田偉 鄭穎t犝，

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