膝关节直立位CT：负重对关节对线的影响。
Upright CT of the knee: the effect of weight-bearing on joint alignment.
作者信息
Hirschmann Anna, Buck Florian M, Fucentese Sandro F, Pfirrmann Christian W A
机构信息
Department of Radiology, Orthopedic University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, 4031, Basel, Switzerland.
出版信息
Eur Radiol. 2015 Nov;25(11):3398-404. doi: 10.1007/s00330-015-3756-6. Epub 2015 May 1.
OBJECTIVES
To prospectively compare patellofemoral and femorotibial alignment in supine non-weight-bearing computed tomography (NWBCT) and upright weight-bearing CT (WBCT) and assess the differences in joint alignment.
METHODS
NWBCT and WBCT images of the knee were obtained in 26 patients (mean age, 57.0 ± 15.9 years; range, 21-81) using multiple detector CT for NWBCT and cone-beam extremity CT for WBCT. Two musculoskeletal radiologists independently quantified joint alignment by measuring femorotibial rotation, tibial tuberosity-trochlear groove distance (TTTG), lateral patellar tilt angle, lateral patellar shift, and medial and lateral femorotibial joint space widths. Significant differences between NWBCT and WBCT were sought using Wilcoxon signed-rank test (P-value < 0.05).
RESULTS
Significant differences were found for femorotibial rotation (the NWBCT mean changed from 2.7° ± 5.1 (reader 1)/2.6° ± 5.6 (reader 2) external rotation to WBCT 0.4° ± 7.7/0.2° ± 7.5 internal rotation; P = 0.009/P = 0.004), TTTG (decrease from NWBCT (13.8 mm ± 5.1/13.9 mm ± 3.9) to WBCT (10.5 mm ± 5.0/10.9 mm ± 5.2; P = 0.008/P = 0.002), lateral patellar tilt angle (decrease from NWBCT (15.6° ± 6.7/16.9° ± 7.4) to WBCT (12.5° ± 7.7/15.0° ± 6.2; P = 0.011/P = 0.188). The medial femorotibial joint space decreased from NWBCT (3.9 mm ± 1.4/4.5 mm ± 1.3) to WBCT (2.9 mm ± 2.2/3.5 mm ± 2.2; P = 0.003/P = 0.004). Inter-reader agreement ranged from 0.52-0.97.
CONCLUSION
Knee joint alignment changes significantly in the upright weight-bearing position using CT when compared to supine non-weight-bearing CT.
KEY POINTS
• Cone-beam extremity CT offers upright weight-bearing examinations of the lower extremities. • Knee alignment changes significantly in an upright position compared to supine position. • Tibial tuberosity-trochlear groove distance (TTTG) is less pronounced in a weight-bearing position. • The weight-bearing position leads to a decrease of the lateral patellar tilt angle.
目的
前瞻性比较仰卧位非负重计算机断层扫描（NWBCT）和直立位负重计算机断层扫描（WBCT）时髌股关节和股胫关节的对线情况，并评估关节对线的差异。
方法
对26例患者（平均年龄57.0±15.9岁；范围21 - 81岁）进行膝关节NWBCT和WBCT检查，NWBCT使用多层螺旋CT，WBCT使用锥形束四肢CT。两名肌肉骨骼放射科医生通过测量股胫旋转、胫骨结节 - 滑车沟距离（TTTG）、髌骨外侧倾斜角、髌骨外侧移位以及内外侧股胫关节间隙宽度，独立对关节对线进行量化。使用Wilcoxon符号秩检验寻找NWBCT和WBCT之间的显著差异（P值<0.05）。
结果
发现股胫旋转存在显著差异（NWBCT时平均为2.7°±5.1（读者1）/2.6°±5.6（读者2）外旋，WBCT时为0.4°±7.7/0.2°±7.5内旋；P = 0.009/P = 0.004），TTTG（从NWBCT时的（13.8 mm±5.1/13.9 mm±3.9）降至WBCT时的（10.5 mm±5.0/10.9 mm±5.2；P = 0.008/P = 0.002），髌骨外侧倾斜角（从NWBCT时的（15.6°±6.7/16.9°±7.4）降至WBCT时的（12.5°±7.7/15.0°±6.2；P = 0.011/P = 0.188）。内侧股胫关节间隙从NWBCT时的（3.9 mm±1.4/4.5 mm±1.3）降至WBCT时的（2.9 mm±2.2/3.5 mm±2.2；P = 0.003/P = 0.004）。读者间一致性范围为0.52 - 0.97。
结论
与仰卧位非负重CT相比，使用CT时膝关节在直立负重位对线有显著变化。
关键点
• 锥形束四肢CT可进行下肢直立负重检查。• 与仰卧位相比，膝关节在直立位时对线有显著变化。• 负重位时胫骨结节 - 滑车沟距离（TTTG）变化不明显。• 负重位导致髌骨外侧倾斜角减小。
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