终末期膝骨关节炎患者体内膝关节动态负荷、静态对线与胫骨软骨下骨微观结构之间的关系。
Relationships between in vivo dynamic knee joint loading, static alignment and tibial subchondral bone microarchitecture in end-stage knee osteoarthritis.
机构信息
The Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.
Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.
出版信息
Osteoarthritis Cartilage. 2018 Apr;26(4):547-556. doi: 10.1016/j.joca.2018.01.014. Epub 2018 Jan 31.
OBJECTIVE
To study, in end-stage knee osteoarthritis (OA) patients, relationships between indices of in vivo dynamic knee joint loads obtained pre-operatively using gait analysis, static knee alignment, and the subchondral trabecular bone (STB) microarchitecture of their excised tibial plateau quantified with 3D micro-CT.
DESIGN
Twenty-five knee OA patients scheduled for total knee arthroplasty underwent pre-operative gait analysis. Mechanical axis deviation (MAD) was determined radiographically. Following surgery, excised tibial plateaus were micro-CT-scanned and STB microarchitecture analysed in four subregions (anteromedial, posteromedial, anterolateral, posterolateral). Regional differences in STB microarchitecture and relationships between joint loading and microarchitecture were examined.
RESULTS
STB microarchitecture differed among subregions (P < 0.001), anteromedially exhibiting highest bone volume fraction (BV/TV) and lowest structure model index (SMI). Anteromedial BV/TV and SMI correlated strongest with the peak external rotation moment (ERM; r = -0.74, r = 0.67, P < 0.01), despite ERM being the lowest (by factor of 10) of the moments considered, with majority of ERM measures below accuracy thresholds; medial-to-lateral BV/TV ratios correlated with ERM, MAD, knee adduction moment (KAM) and internal rotation moment (|r|-range: 0.54-0.74). When controlling for walking speed, KAM and MAD, the ERM explained additional 11-30% of the variations in anteromedial BV/TV and medial-to-lateral BV/TV ratio (R = 0.59, R = 0.69, P < 0.01).
CONCLUSIONS
This preliminary study suggests significant associations between tibial plateau STB microarchitecture and knee joint loading indices in end-stage knee OA patients. Particularly, anteromedial BV/TV correlates strongest with ERM, whereas medial-to-lateral BV/TV ratio correlates strongest with indicators of medial-to-lateral joint loading (MAD, KAM) and rotational moments. However, associations with ERM should be interpreted with caution.
目的
研究术前步态分析、静态膝关节对线和切除胫骨平台的亚皮质骨小梁（STB）微观结构获得的体内动态膝关节负荷指数与终末期膝骨关节炎（OA）患者之间的关系，切除胫骨平台的 STB 微观结构使用 3D 微 CT 进行量化。
设计
25 例计划接受全膝关节置换术的膝关节 OA 患者接受术前步态分析。放射影像学确定机械轴偏差（MAD）。手术后，切除的胫骨平台进行微 CT 扫描，并在四个亚区（前内侧、后内侧、前外侧、后外侧）分析 STB 微观结构。检查了 STB 微观结构的区域差异以及关节负荷与微观结构之间的关系。
结果
STB 微观结构在亚区之间存在差异（P<0.001），前内侧表现出最高的骨体积分数（BV/TV）和最低的结构模型指数（SMI）。前内侧 BV/TV 和 SMI 与最大外旋力矩（ERM；r=-0.74，r=0.67，P<0.01）相关性最强，尽管 ERM 是所考虑的力矩中最低的（低 10 倍），并且大部分 ERM 测量值低于精度阈值；内侧至外侧 BV/TV 比值与 ERM、MAD、膝内收力矩（KAM）和内旋力矩相关（|r|范围：0.54-0.74）。当控制行走速度、KAM 和 MAD 时，ERM 解释了前内侧 BV/TV 和内侧至外侧 BV/TV 比值变化的 11-30%（R=0.59，R=0.69，P<0.01）。
结论
这项初步研究表明，终末期膝 OA 患者胫骨平台 STB 微观结构与膝关节负荷指数之间存在显著关联。特别是，前内侧 BV/TV 与 ERM 相关性最强，而内侧至外侧 BV/TV 比值与内侧至外侧关节负荷（MAD、KAM）和旋转力矩的相关性最强。然而，与 ERM 的关联应谨慎解释。
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