Zhang Yong-Wang, Du Pei-Yu, Li Xi, Liu Lu, Yan Yun-Tao, Bai Yi-Cong, Tian Xin-Yu, Du Shuang-Qing
Department of Orthopaedics, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China.
Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Front Bioeng Biotechnol. 2025 Jul 9;13:1600020. doi: 10.3389/fbioe.2025.1600020. eCollection 2025.
The aim of this study is to explore the correlation between the horizontal deviation of the coronal lumbar spine and the lower limb force line in knee osteoarthritis (KOA).
A retrospective analysis of 233 KOA cases (47 male patients and 186 female patients, aged 50-83 years, with an average of 61.55 ± 8.72 years) admitted from 1 October 2022 to 31 December 2023 was conducted. Bilateral hip, knee, and ankle (HKA) angles; mechanical axis offset distance (MAD); joint line convergence angle (JLCA); lumbar-knee offset distance (LKOD, a self-tested angle reflecting the difference in the position of the bilateral knee joint relative to the lumbar vertebra); Western Ontario and McMaster Universities Arthritis Index (WOMAC) score; and baseline data records were assessed for all patients.
The WOMAC score was correlated with L1, L2, and L3 in LKOD ( < 0.05; r = 0.240, 0.362, and 0.386) but not with L4 and L5 ( > 0.05). WOMAC was also associated with HKA, MAD, and JLCA on the affected side ( < 0.05; r = -0.127, 0.140, and 0.135). The unaffected side and d-values were not associated with HKA, MAD, and JLCA (the d-value represents the absolute value of the difference between the unaffected and affected sides, which represents the overall change in both lower limbs) ( > 0.05). L1-L5 in LKOD was associated with HKA and MAD d-values ( < 0.05); LKOD was not correlated with HKA, MAD, and JLCA on the affected side.
Lumbar horizontal deviation is a risk factor affecting all angles in both lower limbs and may aggravate knee bone and joint symptoms. The influence of horizontal direction changes in the lumbar spine on KOA, especially change in L3, should be prioritized in the clinical treatment and research of KOA.
本研究旨在探讨膝关节骨关节炎（KOA）患者冠状位腰椎水平偏移与下肢力线之间的相关性。
对2022年10月1日至2023年12月31日收治的233例KOA患者（47例男性患者和186例女性患者，年龄50 - 83岁，平均年龄61.55±8.72岁）进行回顾性分析。评估所有患者的双侧髋、膝、踝（HKA）角；机械轴偏移距离（MAD）；关节线汇聚角（JLCA）；腰-膝偏移距离（LKOD，一个反映双侧膝关节相对于腰椎位置差异的自测角度）；西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分；以及基线数据记录。
WOMAC评分与LKOD中的L1、L2和L3相关（P<0.05；r = 0.240、0.362和0.386），但与L4和L5不相关（P>0.05）。WOMAC还与患侧的HKA、MAD和JLCA相关（P<0.05；r = -0.127、0.140和0.135）。健侧和d值与HKA、MAD和JLCA不相关（d值表示健侧与患侧差异的绝对值，代表双下肢的整体变化）（P>0.05）。LKOD中的L1 - L5与HKA和MAD d值相关（P<0.05）；LKOD与患侧的HKA、MAD和JLCA不相关。
腰椎水平偏移是影响双下肢所有角度的危险因素，可能加重膝关节骨与关节症状。在KOA的临床治疗和研究中，应优先考虑腰椎水平方向变化对KOA的影响，尤其是L3的变化。
