Dougados M, Gueguen A, Nguyen M, Berdah L, Lequesne M, Mazieres B, Vignon E
Clinique de Rhumatologie, Hôpital Cochin, Paris, France.
Ann Rheum Dis. 1996 Jun;55(6):356-62. doi: 10.1136/ard.55.6.356.
To determine a cut off value for changes in radiological joint space width that allowed definition of radiological progression of hip osteoarthritis not related to measurement method errors and, thereafter, to determine factors predictive of radiological progression of hip osteoarthritis and to evaluate the correlations between clinical and radiological parameters.
A prospective, longitudinal (one year duration), multicentre study was made of patients with osteoarthritis of the hip (American College of Rheumatology criteria). Data on clinical activity (pain, functional impairment), demographic data (age, gender, body mass index), and femoral head migration (superolateral, superomedial, concentric) were collected when the patient entered the study; radiological grade (joint space width in millimetres at the narrowest point using a 0.1 mm graduated magnifying glass, evaluated by a single observer unaware of the chronology of the films) was recorded at the patient's entry to the study and after one year.
Analysis of the means of the differences between two analyses performed by a single observer of 30 pairs of radiographs (one performed after an interval of one year) (0.06 (SD 0.23)) suggested that a change of more than 0.56 mm (2 SD) after a one year follow up could define progression of osteoarthritis of the hip. Of the 508 patients recruited, 461 (91%) completed the one year follow up and radiological progression was observed in 102 (22%). The factors predictive of radiological progression that were identified in the multivariate analysis were: radiological joint space width at entry < or = 2 mm, superolateral migration of the femoral head, female gender, Lequesne's functional index > 10, age at entry > 65 years (odds ratios 2.11, 4.25, 2.51, 2.66, 1.90, respectively). The level of clinical parameters (pain, functional impairment) and the amount of symptomatic treatment required (non-steroidal anti-inflammatory drugs and analgesic intake) accounted for 20% (p < 0.0001) of the variability of the changes in radiological joint space width over the one year study period.
These data suggest that radiological progression of hip osteoarthritis could be defined by a change in joint space width of at least 0.6 mm after a one year follow up period, is correlated with the changes in clinical status of the patients, and is related not only to demographic data (age, gender), but also to some specific characteristics of osteoarthritis (localisation, radiological severity, clinical activity).
确定放射学关节间隙宽度变化的临界值，以定义与测量方法误差无关的髋骨关节炎放射学进展，此后确定髋骨关节炎放射学进展的预测因素，并评估临床和放射学参数之间的相关性。
对符合髋骨关节炎（美国风湿病学会标准）的患者进行了一项前瞻性、纵向（为期一年）的多中心研究。在患者进入研究时收集临床活动（疼痛、功能障碍）、人口统计学数据（年龄、性别、体重指数）和股骨头移位（上外侧、上内侧、同心）的数据；在患者进入研究时和一年后记录放射学分级（使用0.1毫米刻度放大镜在最窄点测量的关节间隙宽度，由一名不了解胶片时间顺序的观察者评估）。
一名观察者对30对X光片进行的两次分析（一次在间隔一年后进行）之间差异均值的分析（0.06（标准差0.23））表明，一年随访后变化超过0.56毫米（2个标准差）可定义为髋骨关节炎进展。在招募的508名患者中，461名（91%）完成了一年随访，其中102名（22%）观察到放射学进展。多变量分析中确定的放射学进展预测因素为：进入研究时放射学关节间隙宽度≤2毫米、股骨头向上外侧移位、女性、勒凯斯内功能指数>10、进入研究时年龄>65岁（比值比分别为2.11、4.25、2.51、2.66、1.90）。临床参数（疼痛、功能障碍）水平和所需对症治疗量（非甾体抗炎药和镇痛药摄入量）占一年研究期间放射学关节间隙宽度变化变异性的20%（p<0.0001）。
这些数据表明，髋骨关节炎的放射学进展可通过一年随访期后关节间隙宽度至少0.6毫米的变化来定义，与患者临床状态的变化相关，不仅与人口统计学数据（年龄、性别）有关，还与骨关节炎的一些特定特征（定位、放射学严重程度、临床活动）有关。
