| Objectives To study the difference,correlation and clinical significance of lower limb force lines between weight-bearing and non-weight-bearing patients with varus knee osteoarthritis,and to analyze the deviation between pre-operative and intraoperative evaluation reference full-length force lines of lower limbs in weight-bearing position and non-weight-bearing position.Methods From October 2018 to March 2019,according to the Kellgren-Lawrence(KL)grading standard of knee osteoarthritis(KOA),8 knees of grade I-IV osteoarthritis(32knees)were selected from the patients with knee osteoarthritis hospitalized in the Second Hospital of Tangshan City(Orthopaedic Hospital Affiliated to North China University of Technology).There were 22 patients,16 females and 6 males,all of whom were genu varus osteoarthritis.Among them,there were 10 knees,17 left knees and 15 right knees,aged 46-87 years,with an average age of 65 years.Lower extremity full-length X-ray photography was performed in both standing and lying position.The knee varus angle(HKA angle),femoral-tibial angle(FT angle)and joint gap angle(JS angle)were measured respectively in both loading and non-loading positions.The highest and lowest values of both ends were removed and the average values were taken five times by the same attending physician.Then statistical analysis was conducted to analyze the differences and relationships between the weight-bearing and non-weight-bearing positions from different angles and the correlation with the Kellgren-Lawrence(kl)classification of knee osteoarthritis(KOA).Results 1 The average value of weight-bearing inversion angle was 7.203?±3.035,while that of non-weight-bearing inversion angle was 4.928?±2.787,t=9.642,P<0.01,and the difference was 2.275? ± 1.335;The average value of the femoral-tibial angle in the weight-bearing position was 180.538? ± 3.379,while that in the non-weight-bearing position was 178.281? ± 3.119,t=8.175,P<0.01,and the difference was 2.256? ±1.561;The average value of the joint clearance angle was 4.569?±0.968 in the weightbearing position,3.553?±0.935 in the non-weightbearing position,t=8.348,P<0.01,and the difference was 1.016? ± 0.688;The knee varus angle(HKA angle),femoral-tibial angle(FT angle)and joint space angle(JS angle)in the weight-bearing position are larger than those in the non-weight-bearing position,and the difference is statistically significant(P < 0.01).2 There was a positive correlation between weight-bearing varus angle and non-weight-bearing varus angle(r=0.898,P < 0.01);The difference between weight-bearing varus angle and non-weight-bearing varus angle was positively correlated with weight-bearing varus angle(r=0.398,P < 0.05);There was no statistical significance between the difference between them and the correlation coefficient of non-weightbearing varus angle.3 There is a positive correlation between weight-bearing and nonweight-bearing femoral-tibial angles(r=0.874,P <0.01);but there is no significant difference between them and the correlation coefficients between weight-bearing and non-weight-bearing femoral-tibial angles.4 There is a positive correlation between the joint space in the weight-bearing position and that in the non-weight-bearing position,r =0.739,P < 0.01;The difference between the two was positively correlated with the angle of the joint space in the weight-bearing position,r = 0.403,P < 0.05;There is no significant difference between the two groups in the angle of the joint space in the nonweight-bearing position.5 There is a positive correlation between weight-bearing varus angle and weight-bearing femoral-tibial angle(r = 0.937,P < 0.01),and between nonweight-bearing varus angle and non-weight-bearing femoral-tibial angle(r = 0.925,P <0.01).6 There is no significant difference in the correlation coefficients between the inverted angle in the weight-bearing position,the inverted angle in the non-weightbearing position and the joint clearance angle in the weight-bearing position and the nonweightbearing position.7 The mean values of weight-bearing varus angle from(KL)grade I-IV were 3.413? ±0.732 ? 5.813?±0.698 ? 8.600?±1.116 ? 10.988?±1.139 ?r=0.969?P < 0.01.The mean values of weight-bearing varus angle from(KL)grade I-IV from(KL)grade I-IV from(KL)grade I-IV were 1.550?±1.409 ? 4.225?±1.146 ?6.050?±1.584 ? 7.888?±1.878,r=0.842,P < 0.01.There was a positive correlation between the inversion angle of non-weight-bearing position and the grading of(KL).8The average values of weight-bearing femoral-tibial angle graded from(KL)I to IV were176.763?±0.705,178.763?±1.047,181.900?±2.226,184.725?±1.396,r=0.900,P<0.01,respectively.There was a positive correlation between weight-bearing femoral-tibial angle and(KL)classification;the average values of non-weight-bearing femoral-tibial angle from(KL)classification I to IV were 175.075?±1.302,176.875?±1.477,179.613?±1.815,181.563?±2.751,r=0.818,P<0.01,and non-weight-bearing femoraltibial angle was positively correlated with(KL)classification.9 There was no significant difference in the correlation coefficients between the joint clearance angle and the grade in the weight-bearing position and the non-weight-bearing position.Conclusions 1 Comparing the full-length films of lower limbs in weight-bearing position and non-weight-bearing position,it was found that there were differences in knee varus angle(HKA angle),femoral-tibial angle(FT angle)and joint space angle(JS angle).The difference of varus angle was 2.275?±1.335;the difference of femoral-tibial angle was 2.256?±1.561;and the difference of joint space angle was 1.016?±0.688.Therefore,when performing lower limb force line correction surgery,we should fully consider the deviation and correlation between preoperative and intraoperative nonweight-bearing position photographs,in order to facilitate more accurate osteotomy.It is recommended that the pre-operative evaluation plan of osteotomy and orthopaedic surgery be taken at the same time with full-length force line films of the lower extremities in the weight-bearing position and non-weight-bearing position,so as to further guide the fine degree of osteotomy according to the difference between them.2There are differences in different angles between load-bearing position and non-loadbearing position,which are related to the degree of articular cartilage wear and the degree of ligament relaxation.Therefore,the tension of the perigenic ligament and other soft tissues should be taken into account in osteotomy and orthopaedic surgery to reduce the residual angle of deformity after operation.3 With the aggravation of knee osteoarthritis(KL)classification,the degree of knee varus deformity is more serious,and the correlation coefficients between weight-bearing knee varus angle,femoral-tibial angle and KL classification are greater than those of non-weight-bearing position,which indicates that the lower limb force line in weight-bearing position can more truly and accurately reflect the severity of knee osteoarthritis and has more clinical value.Figure twenty-one;Table nine;Reference fifty-two... |
PDF Full Text Request