07_学術_荷重位X線撮影法の違いによる_山口様.indd

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1 Arts and Sciences X Radiological assessment of joint space width using different weight-bearing radiographic methods for knee osteoarthritis Key words: knee, osteoarthritis, radiography, joint space Summary We compared three methods (standing with knee extension method, SynaFlexer method, and modified Rosenberg method) of measuring the plateau gap and joint space width using the bilateral weight-bearing plain radiographs of 17 knee osteoarthritis patients (32 knee joints). The maximum value of the plateau gap of the medial knee joint with each method was 5.8 mm, 3.9 mm, and 2.9 mm, respectively, whereas the minimum value of the joint space width was 4.6 mm, 3.6 mm, and 3.1 mm, respectively. With the SynaFlexer method and the modified Rosenberg method, the X-ray beam can pass parallel to the medial tibial plateau, and the area with the most thinning of femoral condylar cartilage can be observed. Therefore, we believe that the SynaFlexer and modified Rosenberg methods are useful for diagnosing early osteoarthritis and for the assessment of disease severity plateau gap SynaFlexer Rosenbergplateau gap 5.8mm 3.9mm 2.9mm 4.6mm 3.6mm 3.1mm SynaFlexer RosenbergX Osteoarthritis OA 800 X2,500 1 OA Masanori Yamaguchi 1 Hironobu Koseki 2 Kousei Enguchi 1 Hitoshi Iwanaga 3 Shunta Kyuma 1 Hiroyuki Shindo 3 1 Department of Radiology, Wajinkai Hospital 2 Department of Locomotive Rehabilitation Science, Unit of Rehabilitation sciences, Nagasaki University Graduate School of Biomedical Sciences 3 Department of Orthopedic Surgery, Wajinkai Hospital MRI OA X OA OA 2 Kellgren and Lawrence 3 OA Rosenberg Davies OA vol.65 no.783

X 4, 6 OA X X 2 3 X OA 17 32 5 10 12 22 55 84 64.

of the patients Regius model 190 V stage, SynaFlexer TM, Synarc, Inc.

1B 7, 8 10 10 Rosenberg 4 10 20 Fig.1C 50kV 100mA 0.1s 07 A B C Fig.

method C : Modifi ed Rosenberg method The X-ray beam (arrow) was directed in

2 X 4, 6 OA X X 2 3 X OA Table 1 X KXO-80G, CR Computed Radiography Table 1 Physical characteristics of the patients Regius model 190 V stage, SynaFlexer TM, Synarc, Inc.SynaFlexer Rosenberg3 2 X Fig.1A SynaFlexer TM Fig.1B 7, Rosenberg Fig.1C 50kV 100mA 0.1s 07 A B C Fig.1 Radiographic methods A : Standing with knee extension method B: SynaFlexer method C : Modifi ed Rosenberg method The X-ray beam (arrow) was directed in an anteroposterior direction in the Standing with knee extension method, and in a posteroanterior direction in the SynaFlexer and Modifi ed Rosenberg methods

Table 2 Comparisons of the plateau gap and joint space width values with the three methods :

2 Method for measuring plateau gap and joint space width 水準はいずれも 5% 未満とした A: Maximum value of

Rosenberg 両脚に均等に荷重させるように配慮した DICOM 画変法が立位正面法よりも有意に低値であり P <0.05 像に変換してモニター L1750, HP Inc.

法間に有意差は認められなかった内側関節裂幅は plateau gap と同様に Rosenberg 変法で最も狭く立位正面法で最も広く描出されていた P <0.05 Fig.

05 なお全ての計測項目において 3 人の検者間に統計学 17 inch 解像度 1280 1024 に投影し解析ソフト POP-Net Essential ver. 4.

2 各種計測は 3 人の異なる検者が個別に行いその平均値を計測値とした 3 種類の撮影法による計測値を集計し一元配置分散分析法 ANOVA と Tukey-Kramer 法によ

3 Representative X-rays of a 62-year-old woman taken using the three assessment methods A :

3 Table 2 Comparisons of the plateau gap and joint space width values with the three methods : P<0.05 compared to the standing with knee extension method Fig.2 Method for measuring plateau gap and joint space width 水準はいずれも 5% 未満とした A: Maximum value of plateau gap B: Minimum value of joint space width Both measurements were made parallel to the tibial axis. 結果各撮影法での計測値を Table 2 に示す脛骨内側関節は 1m とした撮影時患者をリラックスさせながら面の plateau gap 値は SynaFlexer 法と Rosenberg 両脚に均等に荷重させるように配慮した DICOM 画変法が立位正面法よりも有意に低値であり P <0.05 像に変換してモニター L1750, HP Inc. サイズ Rosenberg 変法は最も低値であったなお脛骨外側関節面の plateau gap 値も SynaFlexer 法で最も低く立位正面法が最も高い値であったが 3 法間に有意差は認められなかった内側関節裂幅は plateau gap と同様に Rosenberg 変法で最も狭く立位正面法で最も広く描出されていた P <0.05 Fig.3 外側関節裂幅は SynaFlexer 法で低くなる傾向が見られたが統計学的有意差は認められなかった ANOVA P >0.05 なお全ての計測項目において 3 人の検者間に統計学 17 inch 解像度に投影し解析ソフト POP-Net Essential ver. 4.2C, イメージワンを用いて脛骨関節面の前縁と後縁の距離最大幅 plateau gap 脛骨関節面の後縁と大骨内側顆部の距離の最小値関節裂幅を計測した Fig.2 各種計測は 3 人の異なる検者が個別に行いその平均値を計測値とした 3 種類の撮影法による計測値を集計し一元配置分散分析法 ANOVA と Tukey-Kramer 法によ的有意差は認められなかったる多重比較検定によって統計学的評価を行った有意 A B C Fig.3 Representative X-rays of a 62-year-old woman taken using the three assessment methods A : Standing with knee extension method Medial plateau gap: 6.4 mm, Medial joint space width: 5.7 mm B : SynaFlexer method Medial plateau gap: 3.6 mm, Medial joint space width: 3.0 mm C : Modified Rosenberg method Medial plateau gap: 2.0 mm, Medial joint space width: 2.6 mm 日本診療放射線技師会誌 vol.65 no.783

4 X Arts and Sciences OA X Rosenberg 4 6 Rosenberg SynaFlexer TM Peterfy 9 Rosenberg SynaFlexer Rosenberg 3 OA X plateau gap 3 3 OA plateau gap SynaFlexer Rosenberg Rosenberg OA Rosenberg OA SynaFlexer X OA OA SynaFlexer Rosenberg X SynaFlexer Rosenberg OA Xplateau gap SynaFlexer Rosenberg plateau gap

5 Table 1 Table 2 Fig.1 Fig.2 Fig.3 Plateau gap P<0.05 a b SynaFlexer c Rosenberg X SynaFlexer Rosenberg A Plateau gapb 62 A plateau gap 6.4mm 5.7mm B SynaFlexer plateau gap 3.6mm 3.0mm C Rosenberg plateau gap 2.0mm 2.6mm 1 Yoshimura N, et al.: Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: The Research on Osteoarthritis/ osteoporosis Against Disability (ROAD) study. J Bone Miner Metab, 27, , Kellgren JH, Lawrence JS: Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 16, , Rosenberg TD, et al.: The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am, 70, , Davies AP, et al.: Plain radiography in the degenerate knee. A case for change. J Bone Joint Surg Br, 81, , X , Charles HC, et al.: Optimization of the fixed-flexion knee radiograph, Osteoarthritis Cartilage, 15, , Kothari M, et al.: Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. Eur Radiol, 14, , Peterfy C, et al.: Comparison of fixed-flexion positioning with fluoroscopic semi-flexed positioning for quantifying radiographic joint-space width in the knee: testretest reproducibility. Skeletal Radiol, 32, , vol.65 no.783

06_学術_関節単純X線画像における_1c_梅木様.indd

06_学術_関節単純X線画像における_1c_梅木様.indd Arts and Sciences X The formulation of femoral heard measurement corrected enlargement ratio using hip joints X-ray Imaging 1 2 1 1 1 2 Key words: Bipolar Hip Arthroplasty (BHA) Preoperative planning Enlargement