Bae Ki-Cheor, Son Eun-Seok, Yon Chang-Jin, Park Jubin, Kim Du-Han
Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Republic of Korea.
Medicina (Kaunas). 2024 Dec 2;60(12):1983. doi: 10.3390/medicina60121983.
: Despite extensive studies of the role of quadriceps and quadriceps/hamstring balance in knee osteoarthritis (OA), the roles of the vastus intermedius, medialis, and lateralis in OA remain unclear. The purpose of this study was to investigate the relationship of lower limb alignment and the ratio of the quadriceps femoris muscle to the knee extensor muscle. : This study included 50 patients with advanced knee OA (Kellgren/Lawrence grade of 3 or 4) and 25 healthy control persons between June 2021 and May 2022. The osteoarthritis grade and anatomical tibiofemoral angle were measured based on plain radiography and scanography. All participants were divided into normal (05°), mild varus (5°10°), and severe varus (>10°) groups. Using MRI, muscle size was determined by calculating the cross-sectional area (CSA) of the total quadriceps (rectus femoris, vastus intermedius, vastus medialis, and vastus lateralis) and its components. : The CSA ratio of the vastus lateralis was significantly smaller in the severe varus group than in the normal or mild varus groups. There was a significant positive correlation between the mechanical tibiofemoral angle and vastus lateralis CSA ( = 0.282, = 0.014) and between the anatomical tibiofemoral angle and vastus lateralis CSA ( = 0.294, = 0.011). There was a significant negative correlation between the mechanical tibiofemoral angle and vastus intermedius CSA ( = -0.263, = 0.023) and between the anatomical tibiofemoral angle and vastus intermedius CSA ( = -0.243, = 0.036). : Patients with severe varus alignment exhibited vastus lateralis atrophy. This study highlights vastus lateralis atrophy in severe varus alignment, though causality between atrophy and varus knee OA remains uncertain. We think that patients with severe varus may require strengthening exercises focused on the vastus lateralis before and after surgery for alignment correction.
尽管对股四头肌以及股四头肌与腘绳肌平衡在膝关节骨关节炎（OA）中的作用进行了广泛研究，但股中间肌、股内侧肌和股外侧肌在OA中的作用仍不明确。本研究的目的是调查下肢力线与股四头肌与膝关节伸肌比例之间的关系。：本研究纳入了2021年6月至2022年5月期间的50例晚期膝关节OA患者（Kellgren/Lawrence分级为3级或4级）和25名健康对照者。基于X线平片和体层扫描测量骨关节炎分级和解剖学胫股角。所有参与者被分为正常（0°至5°）、轻度内翻（5°至10°）和重度内翻（>10°）组。使用磁共振成像（MRI），通过计算股四头肌整体（股直肌、股中间肌、股内侧肌和股外侧肌）及其各部分的横截面积（CSA）来确定肌肉大小。：重度内翻组的股外侧肌CSA比例显著低于正常或轻度内翻组。机械性胫股角与股外侧肌CSA之间存在显著正相关（r = 0.282，P = 0.014），解剖学胫股角与股外侧肌CSA之间也存在显著正相关（r = 0.294，P = 0.011）。机械性胫股角与股中间肌CSA之间存在显著负相关（r = -0.263，P = 0.023），解剖学胫股角与股中间肌CSA之间也存在显著负相关（r = -0.243，P = 0.036）。：重度内翻力线的患者表现出股外侧肌萎缩。本研究强调了重度内翻力线时的股外侧肌萎缩，尽管萎缩与内翻膝关节OA之间的因果关系仍不确定。我们认为，重度内翻患者在进行手术矫正力线前后可能需要进行针对股外侧肌的强化锻炼。
