Correlation Between Imaging Classification Of Knee Osteoarthritis With Tibiofemoral And Patellofemoral Joint Axis Angles,and Traditional Chinese Medicine Syndrome Classification

Objective:Through the study of the correlation between the imaging classification of knee osteoarthritis and the axis angle of tibiofemoral and patellofemoral joints,traditional chinese medicine syndrome classification,the occurrence process of knee osteoarthritis was explored.Methods:A retrospective analysis of middle-aged and elderly patients with KOA who were treated and underwent upright X-ray examination of both lower limbs and lateral knee jointsin the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from September 2018 to December 2020.According to the inclusion criteria,a total of 739 patients(207 male patients and 532 female patients)and 1,026 knees were enrolled.Among them,there were 63 patients with K/L0 grade and 95 knee joints;100 patients with K/L1 grade and 130 knee joints;161 patients with K/L2 grade and 226 knee joints;187 patients with K/L3 grade and knee joints 256;228 K/L4 patients and 319 knee joints.During the discussion of the correlation between the axis angle of the tibiofemoral joint and the K/L grade,the patients were divided into the varus group(the center of the knee is on the outside of the center of the hip and the center of the ankle)and the valgus group(the center of the knee is on the medial side of the center of the hip and the center of the ankle).When the patient’s knee joint center is on the line of the center of the hip joint and the center of the ankle joint,it will be merged into valgus Group discussion.At the same time,when discussing the relationship between the patellofemoral joint axis angle and K/L classification,according to the Install-Salvati method,the patients were reclassified into three groups according to the Install-Salvati method:high patella(patella height>1.2),median patella(0.8≤patella height≤1.2),and low patella(patella height<0.8).Collect data of all research subjects’ gender,age,traditional chinese medicine syndrome classification,lower femur angle,upper tibia angle,femoral neck shaft angle,femoral tibial angle,joint gap angle,hip-knee-ankle angle,patella femoral angle and patella height.KW test was used to compare the collected data between groups,and Spearman correlation coefficient was used to analyze the lower femoral angle,upper tibial angle,femoral neck shaft angle,tibiofemoral angle,joint gap angle,hip-knee-ankle angle,patella femoral angle and patella Correlation test between height and K/L classification.Results:1.In the varus KOA group,the hip-knee-ankle angle,tibiofemoral angle,lower femoral angle,upper tibial angle,joint space angle,and femoral neck shaft angle of patients with different K/L grades have statistical differences between groups Meaning(χ2=498.489,p=0.000;)χ2=430.831,p=0.000;χ2=316.548,p=0.000;χ2=232.782,p=0.000;x2=651.207,p=0.000;χ2=81.336,p=0.000).Hip-knee-ankle angle,tibiofemoral angle,lower femoral angle,upper tibial angle,joint clearance angle and K/L grade have a significant positive correlation at the level of 0.01(r=0.769,p=0.000;r=0.701,p=0.000;r=0.595,p=0.000;r=0.504,p=0.000;r=0.878,p=0.000);the femoral neck shaft angle and K/L grade have a significant negative correlation at the level of 0.01(r=-0.281,p=0.000).2.In the valgus KOA group,the hip-knee-ankle angle,tibiofemoral angle,lower femoral angle,upper tibial angle,joint space angle,and femoral neck shaft angle of patients with different K/L grades have statistically significant differences(χ2=73.935,p=0.000;χ2=81.164,p=0.000;χ2=19.183,p=0.000;χ2=32.667,p=0.000;χ2=113.593,p=0.000;χ2=16.331,p=0.003).Hip-knee-ankle angle,tibiofemoral angle,lower femoral angle,upper tibial angle,and femoral neck shaft angle have a significant negative correlation with K/L grading at the level of 0.01(r=-0.669,p=0.000;r=-0.304,p=0.000;r=-0.333,p=0.000;r=-0.787,p=0.000;r=-0.281,p=0.000);there is a significant positive correlation between joint clearance angle and K/L grade at the level of 0.01(r=-0.626,p=0.000).3.In the high patella group,there are statistically significant differences in the height of the patella and the patella-femoral angle of different K/L grades(χ2=16.438,p=0.002;χ2=10.590,p=0.032);different in the median patella group There is no statistical difference in the height of the patella and the angle of the patella femur in the K/L grade(χ2=3.114,p=0.539;χ2=8.984,p=0.062);There was no statistical difference in the height of the patella of different K/L grades in the low patella group(χ2=3.911,p=0.418),and there was a statistical difference in the patellofemoral angle(χ2=10.879,p=0.028).The patella height and patella femoral angle of the high patella group were significantly positively correlated with the K/L grade at the level of 0.01(r=0.158,p=0.003;r=0.128,p=0.017);the patella height and patella femur in the median patella group There is no correlation between angle and K/L classification(r=-0.048,p=0.256;r=0.077,p=0.070).There is no correlation between the patella height and K/L grade in the low patella group(r=-0.052,p=0.579).The patella femoral angle and K/L grade have a significant negative correlation at the 0.05 level(r=-0.212,p=0.021).4.In traditional Chinese medicine,qi stagnation and blood stasis syndrome and liver and kidney deficiency syndrome were the two most common syndromes of KOA,and the distribution of each syndrome type had statistical significance(P<0.05),and there was significant correlation between syndrome types and K/L classification(r=0.213,P=0.000).Conclusion:1.Old age and female are high risk factors of knee osteoarthritis,and are closely related to the severity of knee osteoarthritis.2.Qi stagnation and blood stasis syndrome and liver and kidney deficiency syndrome are the two most common types of KOA,cold dampness obstruction syndrome and qi blood deficiency syndrome are relatively less,and there is a significant correlation between syndrome types and K/L classification.3.In patients with varus KOA,the lower femoral angle,upper tibial angle,tibiofemoral angle,joint space angle,hip knee ankle angle had significant positive correlation with K/L grade at 0.01 level.There was a significant negative correlation between femoral neck shaft angle and K/L grade at 0.01 level.In the valgus koa group,the lower femoral angle,the upper tibial angle,the tibiofemoral angle,the hip knee ankle angle,and the femoral neck shaft angle were negatively correlated with the K/L grade at the level of 0.01.There was a significant positive correlation between joint space angle and K/L grade at 0.01 level.In the high patella group,there was a significant positive correlation between patella height and K/L grade at 0.01 level.There was a significant positive correlation between patellofemoral angle and K/L grade at 0.05 level.In the median patella group,there was no correlation between patella height and patellofemoral angle and K/L grade.In the low patella group,there was no correlation between patella height and K/L grade,but there was a significant negative correlation between patella femoral angle and K/L grade at the level of 0.05.