腓骨形态与膝关节骨关节炎相关性的影像学研究

doi:10.3877/cma.j.issn.1674-134X.2026.04.008

目的

探索不同严重程度膝骨关节炎患者腓骨形态的差异及作用，以及腓骨形态在不同畸形膝骨关节炎中的差异及作用。

方法

回顾性分析大理白族自治州人民医院2021年1月至2023年10月就诊患者，纳入年满18岁有标准的下肢站立位全长片的符合膝骨关节炎诊断患者，排除存在下肢外伤史或手术史、下肢骨骼发育不良或骨病的患者。最终纳入269例患者（447膝），男75例、女194例，年龄18～86岁。使用Kellgren-Lawrence评分（K-L）评估膝骨关节炎的影像学严重程度。影像学测量指标包括：髋膝踝角、腓骨整体弯曲、近端腓骨弯曲、远端腓骨弯曲、腓骨胫骨距离和胫腓骨间隙面积。单因素分析膝关节骨关节炎发生发展中腓骨形态指标的差异，采用logistic回归分析各腓骨形态指标在膝骨关节炎发生发展中的作用。

结果

随着K-L分级的增加腓骨整体弯曲度、近端腓骨弯曲、远端腓骨弯曲、腓骨胫骨距离和胫腓骨间隙面积在各组之间差异没有统计学意义（均为P＞0.05）。外翻膝骨关节炎中的腓骨近端和远端弯曲程度均大于内翻膝骨关节炎，差异具有统计学意义（t=1.985、-3.642，均为P＜0.05），而腓骨整体弯曲度、腓骨胫骨距离和胫腓骨间隙面积在各组之间差异没有统计学意义（均为P＞0.05）。二分类logistic回归分析显示近端腓骨弯曲［比值比（OR）=1.312，95%置信区间（CI）（1.071，1.607），P=0.009］和远端腓骨弯曲［OR=0.712，95% CI（0.589，0.861），P＜0.001］差异有统计学意义。

结论

本研究发现腓骨形态影像学参数在膝关节骨关节炎严重程度分组中无明显差异。但是发现了腓骨形态影像学参数近端腓骨弯曲和远端腓骨弯曲在内翻和外翻膝骨关节炎中存在差异，近端腓骨弯曲可能是内翻畸形膝骨关节炎的危险因素，而远端腓骨弯曲可能是内翻畸形膝关节骨关节炎的保护因素。

关键词: 膝关节, 骨关节炎, 腓骨, 影像学

Objective

To explore the differences and roles of fibular morphology in patients with knee osteoarthritis of different severity levels, as well as in knee osteoarthritis with various deformities.

Methods

A retrospective analysis was conducted on patients who visited the Dali Bai Autonomous Prefecture People’s Hospital from January 2021 to October 2023. Inclusion criteria: patients aged ≥18 years, with standard standing full-length radiographs of the lower extremities and diagnosis of knee osteoarthritis. Exclusion criteria: history of lower limb trauma or surgery, lower limb skeletal dysplasia or bone diseases. A total of 269 patients (447 knees) were finally included, comprising 75 males and 194 females, with age ranging from 18 to 86 years. The Kellgren-Lawrence (K-L) grading system was used to assess the radiological severity of knee osteoarthritis. Radiological measurement indicators included: hip-knee-ankle angle, total fibular curvature, proximal fibular curvature, distal fibular curvature, fibular-tibial distance, and tibiolfibular interosseous space area. Univariate analysis was first performed to evaluate the differences in fibular morphological indicators in the occurrence and progression of knee osteoarthritis, followed by logistic analysis to determine the role of each fibular morphological indicator in the occurrence and progression of knee osteoarthritis.

Results

With the increase in K-L grading, no significant differences were observed in overall total fibular curvature, proximal fibular curvature, distal fibular curvature, fibular-tibial distance, and tibiolfibular interosseous space area among the groups (P>0.05). The proximal fibular curvature and distal fibular curvature in the varus knee osteoarthritis group were both greater than those in the valgus knee osteoarthritis group, with statistically significant differences (t=1.985, -3.642, both P<0.05), while overall total fibular curvature, fibular-tibial distance, and tibiolfibular interosseous space area showed no significant differences among the groups (all P>0.05). Binary logistic regression analysis indicated that differences in proximal fibular curvature [odds ratio (OR)=1.312, 95% confidence interval (CI) (1.071, 1.607) , P=0.009] and distal fibular curvature (OR=0.712, 95% CI (0.589, 0.861), P<0.001) were statistically significant.

Conclusions

This study found no statistically significant differences in fibular morphological imaging parameters between groups of different severity of knee osteoarthritis. However, differences were observed in the proximal and distal fibular curvatures between varus and valgus knee osteoarthritis. Proximal fibular curvature may be a risk factor for knee osteoarthritis in varus deformity, Distal fibular curvature may also be a protective factor for varus deformity knee osteoarthritis.

Key words: Knee joint, Osteoarthritis, Fibula, Radiology

图1 HKA（髋膝踝角）和FTD（腓骨胫骨距离）测量方法注：HKA为股骨机械轴（A线）和胫骨机械轴（B线）之间的夹角，股骨机械轴定义为连接股骨头中心（由最佳拟合圆确定）和股骨远端最宽处的中点的线，胫骨机械轴定义为膝关节中心和踝关节中心的连线；FTD为腓骨髓腔中点（C点）与胫骨解剖轴（D线）的垂直距离（红色E线）

Figure 1 Measurement methods of HKA (hip-knee-ankle angle) and FTD (fibular tibial distance) Note: HKA is the angle between the mechanical axis of the femur (line A) and the mechanical axis of the tibia (line B). The mechanical axis of the femur is defined as the line connecting the center of the femoral head (determined by the best-fit circle) and the midpoint of the widest part of the distal femur. The mechanical axis of the tibia is defined as the line connecting the center of the knee joint and the center of the ankle joint. FTD is the perpendicular distance (red line E) from the midpoint of the fibular medullary cavity (point C) to the anatomical axis of the tibia (line D)

图2 TFC（腓骨整体弯曲度）、PFC（近端腓骨弯曲度）和DFC（远端腓骨弯曲度）的测量方法注：TFC为腓骨近端髓腔中心线（F线）和腓骨远端髓腔中心线（G线）夹角的内侧角；PFC为腓骨近端髓腔中心线（H线）和中间髓腔中心线（I线）夹角的内侧角；DFC为腓骨远端髓腔中心线（J线）和中间髓腔中心线（I线）夹角的外侧角

Figure 2 Measurement methods of TFC (total fibular curvature), PFC (proximal fibular curvature) and DFC (distal fibular curvature) Note: TFC is the medial angle between the centerline of the proximal fibular medullary cavity (line F) and the centerline of the distal fibular medullary cavity (line G); PFC is the medial angle between the centerline of the proximal fibular medullary cavity (line H) and the centerline of the middle medullary cavity (line I); DFC is the lateral angle between the centerline of the distal fibular medullary cavity (line J) and the centerline of the middle medullary cavity (line I)

图3 TFISA（胫腓骨间隙面积）的测量方法注：TFISA为胫腓骨全长正位X线片上，胫骨外侧缘和腓骨内侧缘之间空间的面积（红色部分）

Figure 3 Measurement method of TFISA (tibiol fibular interosseous space area) Note: TFISA is the area of the space between the lateral border of the tibia and the medial border of the fibula on the anteroposterior full-length radiograph of the tibia and fibula (indicated in red)

表1 不同程度内翻膝OA的影像学测量结果（

x ¯

±s）

Table 1 Radiographic measurement results of different degrees of varus knee OA

K-L分级	例数 Number of cases	TFC（°）	PFC（°）	DFC（°）	FTD（mm）	TFISA（cm²）
Ⅰ	106	177.94±0.17	177.70±0.14	177.28±0.14	31.60±0.40	46.02±1.10
Ⅱ	67	177.80±0.20	177.24±0.17	177.08±0.21	32.50±0.50	46.25±1.17
Ⅲ	68	177.74±0.24	177.69±0.19	177.29±0.15	32.50±0.50	46.64±1.41
Ⅳ	133	177.57±0.16	177.27±0.16	177.03±0.15	32.20±0.40	43.62±0.93
t值		0.496	0.800	0.615	0.270	0.142
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05

表1 不同程度内翻膝OA的影像学测量结果（

x ¯

±s）

Table 1 Radiographic measurement results of different degrees of varus knee OA

K-L分级	例数 Number of cases	TFC（°）	PFC（°）	DFC（°）	FTD（mm）	TFISA（cm²）
Ⅰ	106	177.94±0.17	177.70±0.14	177.28±0.14	31.60±0.40	46.02±1.10
Ⅱ	67	177.80±0.20	177.24±0.17	177.08±0.21	32.50±0.50	46.25±1.17
Ⅲ	68	177.74±0.24	177.69±0.19	177.29±0.15	32.50±0.50	46.64±1.41
Ⅳ	133	177.57±0.16	177.27±0.16	177.03±0.15	32.20±0.40	43.62±0.93
t值		0.496	0.800	0.615	0.270	0.142
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05

表2 内翻和外翻膝关节OA的影像学结果（

x ¯

±s）

Table 2 Radiographic findings of varus and valgus knee OA

类型 Types	例数 Number of cases	TFC（°）	PFC（°）	DFC（°）	FTD（mm）	TFISA（cm²）
膝内翻 Genu varum	374	177.94±0.17	177.46±0.08	177.16±0.09	32.20±0.20	45.32±0.56
膝外翻 Genu valgum	73	177.63±0.11	177.85±0.18	177.34±0.21	31.70±0.50	46.88±1.35
t值		-1.765	1.985	-3.642	-0.885	1.354
P值		＞0.05	＜0.05	＜0.001	＞0.05	＞0.05

表2 内翻和外翻膝关节OA的影像学结果（

x ¯

±s）

Table 2 Radiographic findings of varus and valgus knee OA

类型 Types	例数 Number of cases	TFC（°）	PFC（°）	DFC（°）	FTD（mm）	TFISA（cm²）
膝内翻 Genu varum	374	177.94±0.17	177.46±0.08	177.16±0.09	32.20±0.20	45.32±0.56
膝外翻 Genu valgum	73	177.63±0.11	177.85±0.18	177.34±0.21	31.70±0.50	46.88±1.35
t值		-1.765	1.985	-3.642	-0.885	1.354
P值		＞0.05	＜0.05	＜0.001	＞0.05	＞0.05

表3 内翻和外翻膝OA的logistic回归结果

Table 3 Logistic regression results for varus and valgus knee OA

相关因素 Related factors	回归系数	标准误	Wald χ²值	P值	OR（95% CI）
PFC	0.271	0.104	6.867	0.009	1.312（1.071，1.607）
DFC	-0.340	0.097	12.265	＜0.001	0.712（0.589，0.861）

表3 内翻和外翻膝OA的logistic回归结果

Table 3 Logistic regression results for varus and valgus knee OA

相关因素 Related factors	回归系数	标准误	Wald χ²值	P值	OR（95% CI）
PFC	0.271	0.104	6.867	0.009	1.312（1.071，1.607）
DFC	-0.340	0.097	12.265	＜0.001	0.712（0.589，0.861）

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Imaging study of correlation between fibula morphology and knee osteoarthritis

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Imaging study of correlation between fibula morphology and knee osteoarthritis