Donnelly S, Hart D J, Doyle D V, Spector T D
Department of Rheumatology, Whipps Cross Hospital, Leytonstone, London, United Kingdom.
Ann Rheum Dis. 1996 Feb;55(2):105-8. doi: 10.1136/ard.55.2.105.
To determine whether 'spiking' or angulation of the tibial tubercle is associated with other radiographic markers of osteoarthritis (OA) or pain in the knee joint, and could be taken as a reliable marker for early OA, in a large general population sample.
A total of 950 women from the Chingford general population survey underwent anteroposterior extended weight bearing radiography of the knees. Angulation of the tip of the medial and lateral tubercles, and height of the tubercles above the tibial plateau were measured. These measures were compared with standard radiographic indices including qualitative Kellgren and Lawrence global score, individual scores of osteophytes and joint space narrowing, and pain score. Intraobserver and interobserver reproducibility for assessment of spiking was tested in a subgroup of 50 films using two observers and two readings. Tibial spiking (angulation and height) was defined for this study as the top 10th centile for the whole population. Patients with normal radiographs (Kellgren and Lawrence grade 0) were allocated to quartile groups on the basis of spiking to define severity. Odds ratios were then calculated for the association of spiking and knee pain.
The majority of the measures of tibial spiking were highly reproducible. There was a significant correlation between tibial spike angulation and the presence of osteophytes, but not joint space narrowing. The correlations for spike height with osteophytes and joint space narrowing were poor. There was an association between spike angulation at the lateral tubercle and reported knee pain (odds ratio 1.45 (95% confidence interval 1.03 to 2.03)) after adjustment for age, body mass index, and Kellgren and Lawrence score. There was no association between medial spike angulation or spike height and pain. Among the 950 women, 683 (72%) had normal radiographs (Kellgren and Lawrence = 0); in this group there was a similar association between pain and lateral spike angulation, but not medial spike angulation or spike height.
Tibial spiking is associated with the presence of knee osteophytes and is reproducible, but does not have a strong independent relationship with knee pain. In patients with normal radiographs there is no useful correlation between tibial spiking and pain. Isolated tibial spiking is not a reliable sign of early knee OA, and should not routinely be reported.
在一个大型普通人群样本中，确定胫骨结节的“尖刺样改变”或成角是否与骨关节炎（OA）的其他影像学标志物或膝关节疼痛相关，以及是否可作为早期OA的可靠标志物。
来自钦福德普通人群调查的950名女性接受了膝关节前后位负重扩展X线摄影。测量内侧和外侧结节尖端的成角以及结节高于胫骨平台的高度。将这些测量结果与标准影像学指标进行比较，包括定性的凯尔格伦和劳伦斯整体评分、骨赘和关节间隙变窄的个体评分以及疼痛评分。在一个由50张X线片组成的亚组中，由两名观察者进行两次读数，测试观察者内和观察者间对尖刺样改变评估的可重复性。本研究将胫骨尖刺样改变（成角和高度）定义为整个人群的第90百分位数。根据尖刺样改变将X线片正常（凯尔格伦和劳伦斯分级为0级）的患者分为四分位组以定义严重程度。然后计算尖刺样改变与膝关节疼痛关联的比值比。
胫骨尖刺样改变的大多数测量具有高度可重复性。胫骨尖刺样成角与骨赘的存在之间存在显著相关性，但与关节间隙变窄无关。尖刺样高度与骨赘和关节间隙变窄的相关性较差。在调整年龄、体重指数以及凯尔格伦和劳伦斯评分后，外侧结节的尖刺样成角与报告的膝关节疼痛之间存在关联（比值比1.45（95%置信区间1.03至2.03））。内侧尖刺样成角或尖刺样高度与疼痛之间无关联。在950名女性中，683名（72%）X线片正常（凯尔格伦和劳伦斯=0）；在该组中，疼痛与外侧尖刺样成角之间存在类似关联，但与内侧尖刺样成角或尖刺样高度无关。
胫骨尖刺样改变与膝关节骨赘的存在相关且具有可重复性，但与膝关节疼痛没有很强的独立关系。在X线片正常的患者中，胫骨尖刺样改变与疼痛之间没有有用的相关性。孤立的胫骨尖刺样改变不是早期膝关节OA的可靠征象，不应常规报告。
