Department of Orthopedic Surgery.
Department of Nuclear Medicine.
Medicine (Baltimore). 2021 Jan 8;100(1):e24138. doi: 10.1097/MD.0000000000024138.
Although the importance of quadriceps femoris function was reported previously, little is known about volume-related factors and their effects on clinical outcomes after total knee arthroplasty (TKA). We sought to determine whether there was a bilateral difference in vastus medialis muscle volume measured on single-photon emission computed tomography-computed tomography (SPECT-CT) in patients who underwent unilateral TKA. We also aimed to determine whether vastus medialis volume was related to osteoarthritis (OA) severity or scintigraphic uptake degree around the knee joint on SPECT-CT. And finally, we attempted to investigate the factors, such as vastus medialis volume and scintigraphic uptake degree, associated with the functional outcomes of TKA.This retrospective study included 50 patients (41 female, 9 male) undergone unilateral TKA due to primary OA. The maximal cross-sectional area of the vastus medialis was measured on axial SPECT-CT images. Scintigraphic uptake degrees and Kellgren-Lawrence (K-L) grade at the tibiofemoral joints were assessed. We compared maximal cross-sectional area of the vastus medialis on SPECT-CT for difference of bilateral lower limbs. We also analyzed the relationship between volume of vastus medialis and scintigraphic uptake measured on SPECT-CT and the severity of OA on conventional radiographs. The clinical outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at baseline and at 1 and 2 years after surgery. The relationship between preoperative muscle volume and scintigraphic uptake on SPECT-CT and WOMAC index was analyzed.The amount of muscle volume measured on SPECT-CT was smaller in operated limb in patients who underwent unilateral TKA. Preoperative vastus medialis muscle volume was not related to preoperative OA severity measured on conventional radiographs and scintigraphic uptake on SPECT-CT. However, a decreased vastus medialis muscle volume was related to worse clinical outcomes after TKA (P = .045), whereas the degree of scintigraphic uptake on SPECT-CT was not associated with postoperative clinical outcomes.Muscle volume of vastus medialis was decreased in the operated knee than in the nonoperated knee, and that was correlated with worse postoperative results. Even if the preoperative volume of vastus medialis were not related to OA severity on conventional radiographs and scintigraphic uptake on SPECT-CT, preservation and improvement of the muscle mass of the knee undergoing TKA is important.
虽然股四头肌功能的重要性以前已经被报道过，但对于体积相关因素及其对全膝关节置换术（TKA）后临床结果的影响知之甚少。我们试图确定在接受单侧 TKA 的患者中，单光子发射计算机断层扫描-计算机断层扫描（SPECT-CT）上测量的股内侧肌体积是否存在双侧差异。我们还旨在确定股内侧肌体积与 SPECT-CT 上膝关节周围的骨关节炎（OA）严重程度或闪烁摄取程度是否相关。最后，我们试图研究与 TKA 功能结果相关的因素，如股内侧肌体积和闪烁摄取程度。这项回顾性研究包括 50 名（41 名女性，9 名男性）因原发性 OA 接受单侧 TKA 的患者。在 SPECT-CT 轴位图像上测量股内侧肌的最大横截面积。评估 SPECT-CT 上的闪烁摄取程度和胫股关节的 Kellgren-Lawrence（K-L）分级。我们比较了 SPECT-CT 上双侧下肢股内侧肌的最大横截面积差异。我们还分析了 SPECT-CT 上股内侧肌体积与闪烁摄取程度以及常规 X 线片上 OA 严重程度之间的关系。使用 Western Ontario 和 McMaster 大学骨关节炎（WOMAC）指数在基线和手术 1 年和 2 年后评估临床结果。分析了术前 SPECT-CT 上肌肉体积和闪烁摄取与 WOMAC 指数之间的关系。接受单侧 TKA 的患者，SPECT-CT 上测量的肌肉量在手术肢体中较小。术前股内侧肌体积与常规 X 线片上术前 OA 严重程度和 SPECT-CT 上闪烁摄取无关。然而，股内侧肌体积减少与 TKA 后临床结果较差相关（P = .045），而 SPECT-CT 上的闪烁摄取程度与术后临床结果无关。股内侧肌的肌肉体积在手术膝关节中比在非手术膝关节中减少，并且与术后结果较差相关。即使 SPECT-CT 上股内侧肌的术前体积与常规 X 线片上的 OA 严重程度和闪烁摄取无关，TKA 膝关节的肌肉质量的保存和改善也很重要。
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