膝骨关节炎在下肢静脉曲张发展中的作用

O. Nematzoda, A. Gaibov, S. Kurbanov, KH.A. Toshpulotov, S. Ali-Zade, A. Baratov
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Results: In the SG, oedema and skin trophic changes of the lower limbs (lipodermatosclerosis, eczema) were observed in 39 and 21 cases, respectively. The number amounts to 68.2%, which was 33.4% more compared to the percentage of the CG cases (34.8%, n=32). In the presence of KOA, a varicose transformation of both saphenous veins and their tributaries was more often noted in 36 (40.9%) cases, whereas in CG patients, VVs development occurred only in 6 (6.5%) cases. On the contrary, an isolated varicose transformation of the great saphenous vein (GSV) and its tributaries was more common among CG compared to SG patients, at 93.5% and 55.7%, respectively. Among the examined cohort, the incidence of isolated disease of the small saphenous vein (SSV) and insufficiency of its ostial valve had no significant difference between SG and CG patients and occurred in 3.4% and 6.5% of cases, respectively. 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引用次数: 2

摘要

目的:探讨膝关节关节炎在下肢静脉曲张发生发展中的作用。方法:对180例患者进行观察性横断面队列研究。男性56例(31.1%),女性124例(68.9%)。根据有无膝骨性关节炎来研究VVs的临床特征。研究组(SG)包括88例KOA合并VVs的患者。对照组(CG)包括92名患有VVs且没有膝关节退行性关节疾病的人。两组患者在基本人口学参数、病程和体重指数方面具有可比性。结果:大鼠SG组出现水肿39例,下肢皮肤营养改变(脂皮硬化、湿疹)21例。这一比率为68.2%,比CG (34.8%, n=32)高出33.4%。在KOA存在的情况下,36例(40.9%)患者更常注意到隐静脉及其分支的静脉曲张转化,而在CG患者中,只有6例(6.5%)患者发生静脉曲张。相反,大隐静脉(GSV)及其分支的孤立性静脉曲张转化在CG患者中比SG患者更常见,分别为93.5%和55.7%。在被检查的队列中,SG和CG患者的小隐静脉(SSV)孤立性疾病和其口瓣功能不全的发生率无显著差异,分别为3.4%和6.5%。在SG患者中,同时存在GSV和SSV的口瓣功能不全(n=39;44.3%)和腿部穿静脉不足(n=60;68.2%)更为常见。CG组仅6例(6.5%)和32例(34.8%)出现穿支反流和交通静脉功能不全。SG和CG患者的平均GSV口径差异有统计学意义,分别为12.1±1.4 mm和8.2±0.9 mm。双下肢浅静脉扩张在SG组最常见,分别占90.9%和39.1%。KOA分期与VVs分级直接相关(r=0.58;P <0.001),下肢受累侧度(r=0.63;P <0.001)和疾病复发率(r= 0.59;p < 0.001)。结论:膝关节退行性关节病可导致下肢运动功能受损,是下肢浅静脉曲张转化发生或进展的危险因素之一。因此,需要进一步研究VV患者的下肢生物力学,无论有无KOA。关键词:静脉曲张,膝骨关节炎,静脉高压,口瓣功能不全。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
THE ROLE OF KNEE OSTEOARTHRITIS IN THE DEVELOPMENT OF VARICOSE VEINS IN THE LOWER EXTREMITIES
Objective: To evaluate the role of arthritis of the knee joint in the development and progression of varicose veins of the lower extremities. Methods: An observational cross-sectional cohort study was conducted on 180 patients. There were 56 (31.1%) males and 124 (68.9%) females with VVs of the lower extremities. The VVs' clinical features were studied according to the presence or absence of knee osteoarthritis. The study group (SG) included 88 patients with KOA in combination with VVs. The control group (CG) comprised 92 people suffering from VVs and not having a degenerative joint disease of the knee. Both groups of patients were comparable in terms of basic demographic parameters, disease duration and body mass index. Results: In the SG, oedema and skin trophic changes of the lower limbs (lipodermatosclerosis, eczema) were observed in 39 and 21 cases, respectively. The number amounts to 68.2%, which was 33.4% more compared to the percentage of the CG cases (34.8%, n=32). In the presence of KOA, a varicose transformation of both saphenous veins and their tributaries was more often noted in 36 (40.9%) cases, whereas in CG patients, VVs development occurred only in 6 (6.5%) cases. On the contrary, an isolated varicose transformation of the great saphenous vein (GSV) and its tributaries was more common among CG compared to SG patients, at 93.5% and 55.7%, respectively. Among the examined cohort, the incidence of isolated disease of the small saphenous vein (SSV) and insufficiency of its ostial valve had no significant difference between SG and CG patients and occurred in 3.4% and 6.5% of cases, respectively. In SG patients, concurrent incompetence of the ostial valves of the GSV and SSV (n=39; 44.3%) and insufficiency of leg perforating veins (n=60; 68.2%) were more often noted. In the CG, perforator reflux and incompetence of the communicating veins were present only in 6 (6.5%) and 32 (34.8%) patients, respectively. The mean GSV ostial diameter in SG and CG patients was significantly different and amounted to 12.1±1.4 mm and 8.2±0.9 mm, respectively. Varicose dilatation of the superficial veins of both lower extremities was most often noted in the SG than in CG, 90.9% and 39.1% of the patients, respectively. There was a direct correlation between the KOA stage and such factors as VVs class (r=0.58; p<0.001), the laterality of lower limbs involvement (r=0.63; p<0.001) and disease recurrence (r= 0.59; p<0.001). Conclusion: Degenerative joint disease of the knee, in which the locomotor function of the limb is impaired, can act as one of the risk factors for the development or progression of varicose transformation of the superficial veins of the lower extremities. Therefore, further research is needed to study the lower limb biomechanics in patients with VV, with and without KOA. Keywords: Varicose veins, knee osteoarthritis, venous hypertension, ostial valve incompetence.
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