Imaging Observation On The Morphology Of Spine,Pelvis And Lower Extremities In Patients With Knee Varus Deformity Before Acupotomy

ObjectivesIn this study,by measuring angles related to the lower limb force line distribution on the full-length weight-bearing X-ray of the lower limbs of patients with knee varus deformity and a series of parameters related to the spine and pelvis on the lumbar spine and lateral views,the lower limb force line distribution,pelvic tilt,lumbar lordosis and scoliosis were discribed.Then the correlation between the spine-pelvic-lower extremity morphological changes in patients with knee varus deformity were explored,so as to innovate ideas for the present clinical treatment of this disease.MethodsAccording to the diagnostic criteria,inclusion criteria and exclusion criteria,36 cases of knee varus deformity patients who underwent acupotomy in the outpatient department of Hubei University of Traditional Chinese Medicine Chinese Medicine Hall during the screening study were all bilateral knee varus,and finally 72 cases of knees were obtained.Take the weight-bearing double lower extremity full-length anteroposterior and lumbar vertebral anterior and lateral films before surgery and save them into the computer.Use Photoshopcc2018 software to measure the following parameters:(1)Parameters related to lower extremities force lines: hip,knee and ankle force lines of both lower extremities Angle(Hip-knee-ankle Angle,HKA),Tibia Angle of both lower limbs(Tibia Angle,TA),Femoral angle of both lower limbs(Femoral angle,FA);(2)Parameters related to pelvic shape:coronal pelvic inclination angle(pelvic obliquity angle,POA);Sacral Slope(SS)in the sagittal plane(3)Parameters related to lumbar morphology: the Cobb angle of lumbar lordosis measured on the sagittal plane,and the Cobb angle of lumbar scoliosis measured on the coronal plane,L5 Obliquity Angle(L5 Obliquity Angle,L5OA).Using Excel and SPSS25.0 for statistical processing,Pearson correlation analysis and Spearman rank analysis were used to verify whether the above parameters of patients with knee varus were correlated.Results1.In this study,the measurement of morphological paramet-ers related to the spine-pelvis-lower limbs of 36 cases of knee varus deformity was completed.The average age was 29 years old,the youngest was 15 years old,and the oldest was 59 years old.Among them,16 were males,accounting for 44.4%,and 20 were females,accounting for 55.6%.2.The TA value of the left knee does not obey the normal distribution,so its correlation with other parameters was verified by Spearman rank analysis.Other parameters are in accordance with the normal distribution.Pearson correlation analysis found that(1)in terms of the shape of the lower limbs,the right TA has a linear negative correlation with the right HKA(r=-0.634,P < 0.01),and a linear positive correlation with the left TA(r=0.345,P<0.05);The left TA is linearly negatively correlated with the left HKA(r=-0.752,P<0.01),and linearly positively correlated with the left FA(r=0.595,P<0.01);the left FA is linearly correlated with the left HKA The linear negative correlation(r=-0.556,P<0.01);the right HKA and the left HKA have a linear positive correlation(r=0.683,P<0.01).(2)From the perspective of pelvic shape alone,POA and SS are linearly positively correlated(r=0.368,P<0.05).(3)In terms of the shape of the lumbar spine alone,the Cobb angle of lumbar scoliosis is linearly positively correlated with L5OA(r=0.334,P<0.05);L5OA is linearly positively correlated with the Cobb angle of lumbar lordosis(r=0.350,P<0.05)).(4)In terms of the relationship between the pelvic-lower limb morphology,SS has a linear positive correlation with the right FA(r=0.427,P<0.01);POA has a linear negative correlation with the left HKA(r=-0.431,P<0.01)),linearly positively correlated with the left TA(r=0.460,P<0.01).(5)In terms of the relationship between the spine and the pelvis,L5 OA is linearly positively correlated with POA(r=0.549,P<0.01);Lumbar lordosis Cobb angle is linearly positively correlated with SS(r=0.490,P<0.01).(6)In terms of the relationship between the spine and lower limbs,L5 OA has a linear negative correlation with the right HKA(r=-0.349,P<0.05),and a linear positive correlation with the right FA(r=0.424,P<0.01);The Cobb angle of lumbar lordosis is linearly positively correlated with the right FA(r=0.952,P<0.01).There is no obvious correlation among the other parameters.ConclusionsThis study shows that there is a certain correlation between the spine-pelvic-lower limb force line parameters of patients with knee varus,which is embodied in the following aspects:(1)In terms of the shape of the lower limbs alone,the morphological parameters of the bilateral lower limbs are related.The abnormal distribution of the force line of the ipsilateral lower extremity is related to the tibial angle and femoral angle of the ipsilateral lower extremity;(2)From the perspective of pelvic morphology,the pelvic tilt on the coronal plane is correlated with the sacral tilt on the sagittal plane.(3)In terms of lumbar spine morphology alone,lumbar scoliosis is correlated with L5 vertebral body tilt,while L5 vertebral body tilt is correlated with lumbar lordosis.(4)In terms of the relationship between pelvis-lower extremity morphology,pelvic tilt is related to changes in lower extremity morphology;(5)In terms of the relationship between spine-pelvic morphology,pelvic tilt is related to the tilt of the L5 vertebral body on the coronal plane,and the Lumbar lordosis is related to the tilt of the sacrum;(6)In terms of the relationship between the spine-lower limb shape,the L5 tilt on the coronal plane is related to the shape of the lower limbs,and the shape of the femur is strongly related to the angle of lumbar lordosis.Therefore,clinically for patients with knee varus,the spine,pelvis,and lower extremities are regarded as an organic whole,and the overall acupotomy treatment plan for loosening the soft tissues around the lumbosacral,hip and knee joints is reasonable.