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

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。

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

ObjectiveTo 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. MethodsThis 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. ResultsThere 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. ConclusionsThe 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.