Full-limb and knee radiography assessments of varus-valgus alignment and their relationship to osteoarthritis disease features by magnetic resonance imaging
Full-limb and knee radiography assessments of varus-valgus alignment and their relationship to osteoarthritis disease features by magnetic resonance imaging
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DOI：
10.1002/art.22618
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发表时间：
2007-04-15
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影响因子：
--
通讯作者：
Sharma, Leena
中科院分区：
文献类型：
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作者：
Issa, Sakeba N.;Dunlop, Dorothy;Sharma, Leena
目标。为了检查髋关节-膝关节-踝关节和股骨-胫骨x线片角度之间的相关性，计算偏移量。计算股骨-胫骨角相对于髋关节-膝关节-踝关节角的敏感性、特异性和接受者工作特征（ROC）曲线下的面积，并利用磁共振成像（MRI）检查各入路的不对中与机械应力室骨关节炎（OA）组织病理的关系。膝关节骨性关节炎患者接受了全肢和膝关节x线片以及膝关节MRI检查。采用线性回归确定两个角度是否有系统差异，并确定截止点。采用Dunnett's Most.Results比较MRI分级的对齐方法。在146名参与者中（109名女性，平均年龄70岁，体重指数30.6 kg/m(2)），股骨-胫骨和髋关节-膝关节-踝关节角度相关（r = 0.86； 95%可信区间[95% CI] 0.81, 0.90）。股骨胫骨角平均外翻3.4度（女性3.0度，男性4.7度）；校正后，其识别内翻的敏感性和特异性（预测髋关节-膝关节-踝关节角度）分别为0.84和0.84，外翻的敏感性和特异性分别为0.98和0.73。内翻和外翻的ROC曲线下面积（95% CI）分别为0.91（0.86,0.96）和0.94（0.89,0.99）。随着MRI上内侧病变评分的恶化，内翻严重程度随各对齐测量值的增加而加重。从侧面看，随着病变评分的加重，两种评估方法的外翻均较差。在膝关节骨性关节炎中，膝关节x线片股骨-胫骨角度和全下肢x线片髋关节-膝关节-踝关节角度是相关的。经平均偏移校正后的股骨-胫骨角是敏感的、特异的，并且在识别外翻和内翻对齐方面具有出色的判别能力，ROC曲线下的面积证明了这一点。对齐与特定OA MRI特征之间的关系与两种入路相似。在研究和临床环境中，应考虑使用股骨-胫骨角进行偏移校正。
Objective. To examine the correlation between hip-knee-ankle and femur-tibia radiograph angles, calculate the offset. of the femur-tibia angle with respect to the hip-knee-ankle angle, calculate the sensitivity and specificity and area under the receiver operating characteristic (ROC) curve of the femur-tibia angle, and examine the relationship of malalignment by each approach with osteoarthritis (OA) tissue pathology in the mechanically stressed compartment using magnetic resonance imaging (MRI).Methods. Individuals with knee OA underwent full-limb and knee radiographs and knee MRI. Linear regression was used to determine if the 2 angles differed systematically and to identify the cutoff. Alignment means for MRI grades were compared using Dunnett's Most.Results. In the 146 participants (109 women, mean age 70 years, body mass index 30.6 kg/m(2)), femur-tibia and hip-knee-ankle angles correlated (r = 0.86; 95% confidence interval [95% CI] 0.81, 0.90). On average, the femur-tibia angle was 3.4 degrees more valgus (3.0 degrees in women and 4.7 degrees in men); after correction, its sensitivity and specificity (to predict the hip-knee-ankle angle) were 0.84 and 0.84 for identifying varus and 0.98 and 0.73 for valgus, respectively. The area under the ROC curve (95% CI) was 0.91 (0.86, 0.96) for varus and 0.94 (0.89, 0.99) for valgus. Varus severity worsened comparably with each alignment measure as medial lesion score on MRI worsened. Laterally, as lesion score worsened, comparably worse valgus was seen with either assessment approach.Conclusion. In knee OA, the knee radiograph femur-tibia and full-limb radiograph hip-knee-ankle angles were correlated. The femur-tibia angle, corrected for mean offset, was sensitive, specific, and had excellent discriminative ability for identifying varus and valgus alignment evidenced by area under the ROC curve. The relationship between alignment and specific OA MRI features was comparable with the 2 approaches. Use of the femur-tibia angle, corrected for offset, should be considered in research and clinical settings.