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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (04) : 508 -515. doi: 10.3877/cma.j.issn.1674-134X.2018.04.012

所属专题： 文献；

临床论著

新热成像方法评估膝骨关节炎全膝关节置换术前皮肤温度
杜丹1, 谢东晓1, 刘玮璐2, 宋旻恺1, 马丽云1, 顾疏楠1, 田秋1, 王健2,†()   
  1. 1. 510515　广州，南方医科大学第一临床医学院
    2. 510515　广州，南方医科大学南方医院关节与骨病外科
  • 收稿日期:2017-07-24 出版日期:2018-08-01
  • 通信作者: 王健
  • 基金资助:
    广东省科技计划项目(2014A020209034)

Infrared thermal imaging method assesses preoperative skin temperature differences of knee osteoarthritis

Dan Du1, Dongxiao Xie1, Weilu Liu2, Minkai Song1, Liyun Ma1, Shunan Gu1, Qiu Tian1, Jian Wang2,†()   

  1. 1. The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
    2. Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2017-07-24 Published:2018-08-01
  • Corresponding author: Jian Wang
  • About author:
    Corresponding author: Wang Jian, Email:
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引用本文：

杜丹, 谢东晓, 刘玮璐, 宋旻恺, 马丽云, 顾疏楠, 田秋, 王健. 新热成像方法评估膝骨关节炎全膝关节置换术前皮肤温度[J]. 中华关节外科杂志(电子版), 2018, 12(04): 508-515.

Dan Du, Dongxiao Xie, Weilu Liu, Minkai Song, Liyun Ma, Shunan Gu, Qiu Tian, Jian Wang. Infrared thermal imaging method assesses preoperative skin temperature differences of knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(04): 508-515.

目的

本研究目的是对比一期全膝关节置换术(TKA)前患侧膝关节与对侧膝关节的皮肤温度差异，构建在一期全膝关节术前的膝关节皮肤温度模式，改善现有的热成像筛查方法，寻找膝骨关节炎(OA)的辅助评估方法。

方法

本研究排除术前评定资料不完整及已经手术治疗的OA患者，纳入满足OA诊断标准的初次发病患者31例，均在行一期关节置换术前1 d使用红外热成像仪测量膝关节OA患者的膝关节皮肤温度，记录术前膝关节正面与侧面皮温数据，采用膝关节正面九区侧面六区分区和K-L影像学分级矫正温差的处理方法，进行患侧和对侧皮温对比，计算温差并分析。符合正态分布的数据采用配对t检验，不符合正态分布的数据，采用秩和检验。

结果

正面观中患侧与对侧平均温度比较在髌骨内侧区、髌骨中央区、髌骨内下区、髌骨下区平均温度比较差异有明显统计学意义(t＝2.992、4.188、4.624、4.127，P<0.01)，髌骨内下区为平均温度差异最大区域；外侧面平均温度比较差异均无统计学意义；内侧面中央膝侧区、远端膝侧区平均温差均为患侧高于健侧有明显统计学意义(t＝1.867、0.887，P<0.05)，其中平均温差最大区域为远端膝侧区；在正面观中皮温>31℃、32℃、33℃、34℃、35℃的温度区间内，患侧温度区间所占百分比高于对侧有明显统计学意义(t＝3.097、4.231、4.621、4.574，Z＝3.774；P<0.01)；皮温>30℃的温度区间内，患侧温度区间所占百分比高于对侧有统计学意义(t＝2.311，P<0.05)；而内侧面观和外侧面观中所有节点的患侧和对侧在28℃～36℃区间内节点以上温度区间的所占面积百分比差异均无统计学意义。

结论

膝关节OA患者患侧膝关节皮温较对侧明显增高，膝盖内下区域为平均温差最大区域，膝关节温度面积分布以正面差异明显，以33℃为节点时，节点以上温度区间面积比的差值最大，可能为以后膝关节OA术前的评估与诊断提供一个新的思路；新型热成像技术是适用于膝关节OA术前辅助评估的新方法。

关键词: 关节形成术, 膝关节, 皮肤温度, 炎症
Objective

To improve the infrared thermal imaging screening method and compare the skin temperature difference between the affected knee and the contralateral knee before the total knee arthroplasty(TKA), and to establish the pattern of knee skin temperature before knee surgery that may be significant for early auxiliary evaluation of knee joint osteoarthritis.

Methods

This study excluded the knee joint osteoarthritis patients which had incomplete preoperative evaluation information and were treated with surgery. Thirty-one patients who met the criteria of knee joint osteoarthritis diagnosis were included in the study; their knee joint skin temperature images were captured one day before TKA by infrared thermography. This study adopted the method of comparing the affected knee and the contralateral knee to calculate the temperature difference and analyzed a new partition of the anterior aspect and the side face of knee. The t test was applied to the normal distribution data, while the rank sum test was used to the nonnormal distribution data.

Results

There was statistically significant in every region mean temperature difference(MTD) between the affected side and contralateral side in the anterior aspect (P<0.05). Among them, the MTD regions of medial, patella central, inferomedial, inferior were highly statistically significant (t=2.992, 4.188, 4.624, 4.127; all P<0.01). The most different region of MTD was the inferomedial. In the lateral side, it has no statistic significance of MTD. In the medial side, the central-knee and distal-knee region MTD were statistically significant(t=1.867, 0.887; both P<0.05). The most different region of MTD was the distal-knee. Besides, the percentages of the area between the affected side and contralateral side were statistically significant different in the temperature range above 31℃, 32 ℃, 33 ℃, 34 ℃, 35 ℃ in the anterior aspect (t=3.097, 4.231, 4.621, 4.574, Z=3.774; all P<0.01). And there was statistically significant difference in the temperature range above 30℃(t=2.311, P <0.05). The percentages of the area between the affected side and contralateral side was no statistically significant different above the node from 28 ℃ to 36 ℃ in the lateral side and the medial side.

Conclusions

The affected knee skin temperature of patients with knee osteoarthritis is higher than the contralateral side of the knee and the maximum difference region of MTD may be the inferomedial of the affected knee. There is an obvious difference in the anterior aspect of the knee joint temperature area distribution. The max value of area ratio difference is in the temperature range above 33℃. These research results may provide an idea to early assisted assessment knee osteoarthritis with suitable new type of thermal imaging technology.

Key words: Arthroplasty, knee, Skin temperature, Inflammation
图1 热成像膝关节正面分区。line 1及line 5：髌骨上缘，line 2及line 6：髌骨下缘，line 3及line 8：髌骨外侧缘，line 4及line 7：髌骨内侧缘。b.热成像膝关节侧面分区。line 1：髌骨上缘沿侧面走行的延长线，line 2：髌骨下缘沿侧面走行的延长线，line 3：膝关节侧面中线，line 4：与中间区域等距离的line 1平行线，line 5：与中间区域等距离的line 2平行线
图2 皮肤温度灰度区间正面分区。正面分区以髌骨上下缘高度为基础单位，选取3倍髌骨高度的膝关节区域为感兴趣区域，分析皮肤温度区域分布特点
图3 皮肤温度灰度区间侧面分区。侧面分区以髌骨上下缘侧边延长线宽度为基础单位，选取3倍基础宽度的膝关节区域为感兴趣区域，分析皮肤温度区域分布特点
表1 双侧膝关节正面皮肤温度差对比[n＝31, ℃，(±s)]
项目 正面1区 正面2区 正面3区 正面4区 正面5区 正面6区 正面7区 正面8区 正面9区
患侧温度 32.5±1.4 31.9±1.6 31.6±1.7 32.6±1.5 32.1±1.6 32.0±1.8 32.6±1.5 32.5±1.6 31.9±1.5
对侧温度 32.5±1.4 31.7±1.4 31.6±1.4 32.2±1.5 31.6±1.5 31.8±1.4 32.0±1.5 32.0±1.4 31.9±1.4
t值 0.051 0.936 －0.251 2.992 4.188 0.974 4.624 4.127 0.449
P值 >0.05 >0.05 0.803 <0.01 <0.01 >0.05 <0.01 <0.01 >0.05
表2 双侧膝关节内侧面皮肤温度差对比[n＝31, ℃，(±s)]
项目 内侧1区 内侧2区 内侧3区 内侧4区 内侧5区 内侧6区
患侧温度 32.7±1.3 32.7±1.4 32.6±1.4 32.6±1.4 32.6±1.5 32.4±1.4
对侧温度 32.5±1.5 32.3±1.6 32.0±1.6 32.5±1.5 32.4±1.5 32.4±1.3
t值 0.617 1.867 0.887 1.003 0.971 1.34
P值 >0.05 <0.01 <0.01 >0.05 >0.05 >0.05
表3 双侧膝关节外侧面皮肤温度差对比[n＝31, ℃，(±s)]
项目 外侧1区 外侧2区 外侧3区 外侧4区 外侧5区 外侧6区
患侧温度 32.3±1.2 32.6±1.3 32.6±1.1 32.5±1.2 32.8±1.2 32.6±1.0
对侧温度 32.1±1.2 32.2±1.3 32.4±1.2 32.3±1.4 32.6±1.4 32.4±1.4
t值 1.431 2.984 3.46 0.593 0.91 0.23
P值 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表4 双侧膝关节正面皮肤温度区域面积百分比(n＝31，%)
温度节点 29℃(±s) 30℃(±s) 31℃(±s) 32℃(±s) 33℃(±s) 34℃(±s) 35℃M(P25, P75)
患侧平均温度区域 95.5±18.3 93.1±19.0 86.7±21.4 74.9±25.7 53.7±27.4 27.8±21.8 4.5(0.4，7.6)
对侧平均温度区域 94.8±18.5 89.1±21.0 78.5±26.3 60.1±29.6 34.0±23.8 11.7±11.5 0.8(0.3，1.7)
统计值 t＝0.695 t＝2.311 t＝3.097 t＝4.231 t＝4.621 t＝4.574 Z＝3.774
P值 >0.05 <0.05 <0.01 <0.01 <0.01 <0.01 <0.01
表5 双侧膝关节外侧面皮肤温度区域面积百分比(n＝31，%)
温度节点 29℃(±s) 30℃(±s) 31℃(±s) 32℃(±s) 33℃(±s) 34℃(±s) 35℃M(P25, P75)
患侧平均温度区域 96.3±17.9 95.1±18.1 90.3±19.2 75.8±24.8 53.8±27.0 24.2±17.1 1.1(0.6，7.0)
对侧平均温度区域 95.7± 18.2 94.4±18.8 88.0±20.6 73.1±25.0 48.6±25.9 19.2±15.9 1.6(0.7，5.4)
统计值 t＝0.970 t＝0.530 t＝1.150 t＝1.122 t＝1.701 t＝1.555 Z＝0.175
P值 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表6 双侧膝关节内侧面皮肤温度区域面积百分比(n＝31，%)
温度节点 29℃(±s) 30℃(±s) 31℃(±s) 32℃(±s) 33℃(±s) 34℃(±s) 35℃M(P25, P75)
患侧平均温度区域 99.6±1.8 98.2±5.7 92.2±12.7 78.4±21.4 58.14±27.0 30.8±21.7 4.2(0.8，9.4)
对侧平均温度区域 98.4±5.7 97.0±10.3 91.4±15.7 77.8± 22.5 56.90±29.3 29.3±25.5 1.8(0.7，7.9)
统计值 t＝1.380 t＝0.810 t＝0.489 t＝0.180 t＝0.354 t＝0.524 Z＝1.117
P值 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
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