不同角度下照膝關節正面相評估退化性關節炎之軟骨磨損程度之差異

Radiographic Evaluation of Asticular Wear in Knees with Osteoarthritis-A Comparison between Standard Standing AP and Semiflex Weight AP View

劉銘華(Ming-Hwa Liu) ； 卓原仲(Yuan-Chung Cho) ； 邱方遙(Fang-Yao Chiu) ； 葛平夷(Ping-Yi Ko) ； 張政彥(Cheng-Yen Chang)

《中華放射線技術學雜誌》 30卷1期 (2006/06) Pp. 57-62

https://doi.org/10.30045/CJRT.200606.0007

摘要

有鑒於膝關節退化性關節炎之病患日益增多，為能提早診斷出病因，台北榮民總醫院骨科部與放射線部，利用膝關節承受不同力學之X光攝影技術，以評估「軟骨磨損之程度與部位」，除可提供臨床醫師診斷之依據外，也可改善病人之日常生活品質。本院自93年3月至93年9月共收集100位臨床醫師疑似膝關節退化性關節炎病患，男性50位、女性50位，分別給予膝關節伸直站立(standing)與彎曲30°(flexion)之投射姿勢，並測量在承受不同力學情況下膝關節空隙(joint space)，來評估何種方式較具診斷價值；本研究所使用之X光機型為Toshiba Model TE-6 TR-6，富士數位影像系統(FCR)及台灣電腦公司之PACS系統。結果發現，右腳伸直時關節間隙小於右腳彎曲佔51%，表示右膝關節軟骨前方磨損較後方嚴重。右腳伸直之關節間隙等於右腳彎曲佔19%，表示前後方之軟骨磨損一樣。右腳伸直關節間隙大於右腳彎曲佔30%。表示軟骨磨損後方較前方嚴重。而左腳伸直關節間隙小於左腳彎曲佔49%。左腳伸直等於左腳彎曲佔25%。左腳伸直大於左腳彎曲佔26%。此研究中發現，軟骨磨損並非侷限於某個部位，經統計後發現前方磨損較後方多，建議年長病患申請照膝關節站立姿勢時(standing knee)，應standing與flexion姿勢同時檢查較具臨床診斷價值。

關鍵字

退化性關節炎 ； 膝關節 ； 磨損 ； 軟骨 ； 站立 ； 彎曲

並列摘要

As increased number of elder population in our society, the prevalence of osteoarthritis of knee is steadily growing. In order to make early diagnosis of this disease, we have tested a modified radiographic technique to image knee joint under loading at two different positions to assess the location and extent of articular cartilage wearing. These data may provide useful information for clinician not only to make a diagnosis but also facilitate effective treatment.
From March 2004 to September 2004, 100 patients with clinically suspicious osteoarthritis of knee, including 50 male and 50 female patients, were enrolled to this study. Knee joint radiographs were taken in the standing position with knee full extension and with 30° flexion, respectively. We measured the knee joint space on the radiographs taken under two different loading conditions to determine which position is more diagnostic. In this study, we use Toshiba Model TE-6 TR-6, Fuji Computer Radiograph (FCR) and PACS in our institution.
The data showed that the more narrow joint space of the right knee was seen on the radiograph taken with knee full extension in 51% of all patients, suggestive of more severe cartilage wearing at the anterior part of right knee joint. 19% patients did not show difference on the extent of joint space narrowing at these two positions. 30% patients showed more joint space narrowing at slight knee flexion, suggestive of more cartilage wearing at the posterior part of right knee joint. For the left knee radiographs, more joint space narrowing was found at knee extension position in 49% of the subjects; similar in extent was noted in 25% of patients; less joint space narrowing at knee extension in 26% of patients.
Our data suggested that articular cartilage wearing was not invariably localized. However, more cartilage wearing at the anterior part of knee was shown. We recommended that the positioning of standing-knee radiography for the elder patients should include both knee positions, namely full extension and 30° flexion of knee joint.

並列關鍵字

osteoarthritis ； knee joint ； abrasion ； cartilage ； standing ； flexion