Buckland-Wright J C, Wolfe F, Ward R J, Flowers N, Hayne C
Division of Anatomy, Human and Cell Biology, King's College, Guy's, Kings, and St. Thomas Hospital's Medical School, London, UK.
J Rheumatol. 1999 Dec;26(12):2664-74.
To improve the radiographic assessment of cartilage loss, as measured by joint space width (JSW) in patients with osteoarthritis (OA) of the knees required to detect the effect of structure modifying drugs in OA trials. This was achieved by determining which of 3 nonfluoroscopic radiographic views--standing extended, semiflexed, and schuss--produced the most accurate radioanatomic positioning of the joint and greater reproducibility in joint repositioning and JSW measurement.
Knees from 74 patients with OA of the knees who had medial tibiofemoral compartment JSW > or =2 mm in all views were studied. For all 3 radiographic views, accuracy in the radioanatomic positioning of the knee was determined for both joint rotation and flexion. Reproducibility in joint repositioning and JSW measurement were determined from the difference between repeat examinations taken within 2 h.
About 86% of knees in the 3 views had accurate rotational position of the joint at each visit. Radioanatomically, knees in the semiflexed view were significantly more accurately positioned in regard to knee flexion (p<0.0005) than in the schuss view, which in turn was better (p<0.014) than in the extended knee view. Joint repositioning was significantly more reproducible in the semiflexed (p<0.0001) than in the extended knee, which was better (p<0.013) than in the schuss position. JSW measurement was significantly more reproducible in the semiflexed (p<0.014) than both schuss and extended knee positions, which were not significantly different from each other.
Protocols defining the nonfluoroscopic radiographic procedures for the semiflexed view provide the most accurate radioanatomic joint positioning, and the most reproducible joint repositioning and JSW measurement. Using this method significantly fewer knees would be required to detect significant JSW changes in a structure modifying drug trial compared to the schuss and the extended knee positions.
改善对软骨丢失的影像学评估，软骨丢失通过关节间隙宽度（JSW）来衡量，这对于检测骨关节炎（OA）试验中结构改良药物的效果是必需的。通过确定三种非荧光透视影像学视图（站立伸展位、半屈曲位和切线位）中的哪一种能产生最准确的关节放射解剖定位以及在关节重新定位和JSW测量中具有更高的可重复性来实现这一目的。
研究了74例膝骨关节炎患者的膝关节，这些患者在所有视图中内侧胫股关节间的JSW≥2mm。对于所有三种影像学视图，确定膝关节在关节旋转和屈曲方面放射解剖定位的准确性。关节重新定位和JSW测量的可重复性通过2小时内重复检查之间的差异来确定。
在每次检查时，三种视图中约86%的膝关节具有准确的关节旋转位置。从放射解剖学角度来看，半屈曲位视图中的膝关节在膝关节屈曲方面的定位明显比切线位视图更准确（p<0.0005），而切线位视图又比伸展位膝关节视图更好（p<0.014）。关节重新定位在半屈曲位（p<0.0001）比伸展位膝关节更具可重复性，伸展位膝关节又比切线位更好（p<0.013）。JSW测量在半屈曲位（p<0.014）比切线位和伸展位膝关节更具可重复性，后两者之间无显著差异。
定义半屈曲位非荧光透视影像学程序的方案提供了最准确的关节放射解剖定位、最具可重复性的关节重新定位和JSW测量。与切线位和伸展位膝关节相比，使用这种方法在结构改良药物试验中检测JSW的显著变化所需的膝关节数量明显更少。
