膝关节固定屈曲位X线摄影检测关节间隙变窄的纵向性能评估与验证

Longitudinal performance evaluation and validation of fixed-flexion radiography of the knee for detection of joint space loss.

作者信息

Nevitt Michael C, Peterfy Charles, Guermazi Ali, Felson David T, Duryea Jeff, Woodworth Thasia, Chen Hepei, Kwoh Kent, Harris Tamara B

机构信息

University of California, San Francisco, CA 94107, USA.

出版信息

Arthritis Rheum. 2007 May;56(5):1512-20. doi: 10.1002/art.22557.

DOI:10.1002/art.22557

PMID:17469126

Abstract

OBJECTIVE

The ability of nonfluoroscopically guided radiography of the knee to assess joint space loss is an important issue in studies of progression and treatment of knee osteoarthritis (OA), given the practical limitations of protocols involving fluoroscopically guided radiography of the knee. We evaluated the ability of the nonfluoroscopically guided fixed-flexion radiography protocol to detect knee joint space loss over 3 years.

METHODS

We assessed the same-day test-retest precision for measuring minimum joint space width (JSW), the sensitivity for detection of joint space loss using serial films obtained a median of 37 months (range 23-47 months) apart, and the relationship of joint space loss to radiographic and magnetic resonance imaging (MRI) measures of knee OA. Participants were men and women (ages 70-79 years) with knee pain who were participating in the Health, Aging, and Body Composition Study. We assessed baseline radiographic OA and measured JSW using a computerized algorithm. Serial knee MRIs obtained over the same interval were evaluated for cartilage lesions.

RESULTS

A total of 153 knees were studied, 35% of which had radiographic OA at baseline. The mean +/- SD joint space loss for all knees over 3 years was 0.24 +/- 0.59 mm (P < 0.001 for change). In knees with OA at baseline, the mean +/- SD joint space loss over 3 years was 0.43 +/- 0.66 mm (P < 0.001), and in knees with joint space narrowing at baseline, joint space loss was 0.50 +/- 0.67 mm (P < 0.001). Joint space loss and its standardized response mean increased with the severity of baseline joint space narrowing and with the presence of cartilage lesions at baseline and worsening during followup.

CONCLUSION

Radiography of the knee in the fixed-flexion view provides a sensitive and valid measure of joint space loss in multiyear longitudinal studies of knee OA, without the use of fluoroscopy to aid knee positioning.

摘要

目的

鉴于涉及膝关节荧光镜引导下放射摄影的方案存在实际局限性，在膝关节骨关节炎（OA）进展和治疗研究中，非荧光镜引导下膝关节放射摄影评估关节间隙丢失的能力是一个重要问题。我们评估了非荧光镜引导下固定屈曲位放射摄影方案在3年内检测膝关节间隙丢失的能力。

方法

我们评估了测量最小关节间隙宽度（JSW）的同日重测精度、使用相隔中位数为37个月（范围23 - 47个月）获得的系列X线片检测关节间隙丢失的敏感性，以及关节间隙丢失与膝关节OA的放射学和磁共振成像（MRI）测量指标之间的关系。参与者为参与健康、衰老和身体成分研究的70 - 79岁有膝关节疼痛的男性和女性。我们评估了基线放射学OA情况，并使用计算机算法测量JSW。对在相同时间段内获得的系列膝关节MRI进行软骨损伤评估。

结果

共研究了153个膝关节，其中35%在基线时有放射学OA。所有膝关节在3年内的平均±标准差关节间隙丢失为0.24±0.59 mm（变化P < 0.001）。基线时有OA的膝关节在3年内的平均±标准差关节间隙丢失为0.43±0.66 mm（P < 0.001），基线时有关节间隙变窄的膝关节，关节间隙丢失为0.50±0.67 mm（P < 0.001）。关节间隙丢失及其标准化反应均值随基线关节间隙变窄的严重程度、基线时软骨损伤的存在以及随访期间的恶化而增加。