成人KBD跟骨CT三维重建数据测量及临床意义

Measurement of Adult KBD Calcaneal CT Three-Dimensional Reconstruction Data and Its Clinical Significance

摘要: 目的：利用CT影像资料对成人KBD (Kashin-Beck Disease, KBD)患者跟骨相关参数进行测量，初步明确成人KBD患者跟骨解剖形态，为KBD患者诊疗提供一定的参考依据。方法：选取2018年11月至2018年12月之间陕西省KBD流行病区的KBD患者和正常成人进行踝关节CT平扫，其中KBD患者59例，118踝(左：59；右：59)，平均年龄(61.36 ± 7.98)岁，平均BMI (23.42 ± 2.55)；正常成人56例，108踝(左：53；右：55)，平均年龄(59.46 ± 6.99)岁，平均BMI (23.64 ± 2.54)。通过CT三维重建的方式，以点、线、面三元素相结合的方法测量跟骨跟轴长度、后突长度、前突长度、前突高度、跟骨宽、跟骨沟部长、跟骨后高、跟骨最高、跟骨沟部高、跟骨体积、跟骨表面积、后关节面的面积、Gissane’s角、Böhler角。比较不同分度KBD患者与正常成人跟骨解剖形态参数差异。结果：成人KBD组跟轴长度、前突长度、跟骨宽、跟骨宽、跟骨后高、跟骨最高、跟骨沟部高、跟骨体积、跟骨表面积、Gissane’s角、Böhler角显著小于正常成人组(P < 0.05)；后关节突长度、前突高度、后关节面的面积两组之间无显著差异(P > 0.05)。与成人KBDI度相比，II度与III度跟轴长度、前突长度、前突高度、跟骨宽、跟骨沟部长、跟骨后高、跟骨最高、跟骨沟部高、跟骨体积、跟骨表面积均显著减小(P < 0.01)。与I度及II度患者相比，III度患者Gissane’s角显著减小(P < 0.01)；后关突长度、后关节面的面积、Böhler角III度之间无显著统计学意义(P > 0.05)。结论：成人KBD患者跟骨短缩，高度降低，前、中关节面融合增多，后关节面膨大，跟骨体积明显变小，Gissane’s角减小，Böhler角增大，且男性较女性跟骨变化更为显著。

Abstract: Objective: To measure the calcaneal parameters of adult patients with KBD (Kashin-Beck disease) by using CT image data, and to preliminarily define the calcaneal anatomical morphology of adult patients with KBD, so as to provide some reference for the diagnosis and treatment of patients with KBD. Methods: From November 2018 to December, 2018, KBD patients and normal adults in KBD endemic areas in Shaanxi Province were selected for ankle CT plain scan, including 59 patients with KBD, 118 ankles (left: 59; right: 59), with an average age of (61.36 ± 7.98) years and an average BMI of (23.42 ± 2.55); 56 normal adults, 108 ankles (left: 53; right: 55), with an average age of (59.46 ± 6.99) years and an average BMI of (23.64 ± 2.54). By means of CT three-dimensional re-construction, the calcaneal axis length, kyphosis length, protrusion length, protrusion height, cal-caneal width, calcaneal sulcus length, calcaneal posterior height, calcaneal highest, calcaneal sulcus height, calcaneal volume, calcaneal surface area, posterior articular surface area, Gissane’s angle and Böhler angle were measured, to compare the anatomical parameters of calcaneus between KBD patients with different grades and normal adults. Results: The length of the calcaneal axis, protru-sion length, calcaneal width, calcaneal width, calcaneal posterior height, calcaneal height, calcaneal groove height, calcaneal volume, calcaneal surface area, Gissane’s angle and Böhler angle in adult KBD group were significantly lower than those in normal adult group (P < 0.05). There was no sig-nificant difference in the length of posterior articular process, the height of anterior process and the area of posterior articular surface between the two groups (P > 0.05). Compared with adult KBD I, the length of calcaneus axis, protrusion length, protrusion height, calcaneal width, calcaneal groove length, calcaneal posterior height, calcaneal height, calcaneal groove height, calcaneal volume and calcaneal surface area of II and III degrees were significantly reduced (P < 0.01). Compared with pa-tients with degree I and II, the angle of Gissane’s in patients with degree III was significantly re-duced (P < 0.01). There was no significant difference among the length of posterior coronoid process, the area of posterior articular surface and the angle of Böhler III (P > 0.05). Conclusion: In adult pa-tients with KBD, the calcaneus shortens, the height decreases, the fusion of anterior and middle ar-ticular surfaces increases, the posterior articular surface expands, the calcaneus volume decreases obviously, the Gissane's angle decreases, and the Böhler angle increases, and the calcaneus changes more significantly in men than in women.