A prediction model for coronal malalignment of the lower extremity in middle-aged and young people based on body surface big data

Xizhen ZUO; Liming LIU; Kai LEI; Pengfei YANG; Dejie FU; Lin GUO

doi:10.16016/j.2097-0927.202312116

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A prediction model for coronal malalignment of the lower extremity in middle-aged and young people based on body surface big data

Clinical Medicine | 更新时间：2026-01-09

- A prediction model for coronal malalignment of the lower extremity in middle-aged and young people based on body surface big data
- Journal of Army Medical University Vol. 46, Issue 8, Pages: 868-877(2024)
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院：运动医学中心
  2.400038 重庆，陆军军医大学(第三军医大学)第一附属医院：创伤关节外科
- 作者简介：
- 基金信息：
  
  the Joint Medical Research Project of Chongqing Science and Technology Commission and Chongqing Health Commission(2022MSXM007)
- DOI：10.16016/j.2097-0927.202312116
  CLC： R195.4;R319;R658.3
- Received：06 December 2023，
  
  Revised：2024-01-18，
  
  Published：30 April 2024
- 稿件说明：
移动端阅览
Xizhen ZUO, Liming LIU, Kai LEI, et al. A prediction model for coronal malalignment of the lower extremity in middle-aged and young people based on body surface big data[J]. Journal of Army Medical University, 2024, 46(8): 868-877.
DOI：

Xizhen ZUO, Liming LIU, Kai LEI, et al. A prediction model for coronal malalignment of the lower extremity in middle-aged and young people based on body surface big data[J]. Journal of Army Medical University, 2024, 46(8): 868-877. DOI： 10.16016/j.2097-0927.202312116.

摘要

目的

基于体表大数据构建我国中青年下肢冠状面力线不良预测模型，为临床工作提供更加快速、准确的下肢冠状面力不良预测方法。

方法

采用横断面研究设计方案，筛选陆军军医大学第一附属医院运动医学中心2022年5月至2023年12月收治的915例膝关节半月板撕裂患者的病历资料，测量其下肢冠状面力线(简称下肢力线)。按照下肢力线分级标准将915例患者分中立位下肢力线及下肢力线不良两组，按照7∶3随机分为训练集和验证集。分析训练集性别、年龄及体表大数据(包括BMI、下肢长、双膝距、双踝距、皮下脂肪厚度)的7项指标用于预测下肢力线不良的价值，建立Logistic回归模型并使用列线图对模型进行可视化，使用校准曲线、ROC曲线和DCA曲线评估模型对下肢力线不良的诊断效能。

结果

训练集640例，其中男性299例，女性341例，中位年龄41.5岁；验证集275例，其中男性128例，女性147例，中位年龄41.0岁。训练集中中立位下肢力线和下肢力线不良两组间的性别、年龄、BMI等7项指标之间的差异均有统计学意义(

0.01)。多因素Logistic回归构建了含BMI[(24.31±3.58) kg/m

；

=1.12，95%

：1.06~1.19，

0.001

]

、下肢长[82.00(78.00~87.00)cm；

=0.95，95%

：0.92~0.98，

=0.002

]

、双膝距[30.00(16.00~45.25)mm；

=1.06，95%

：1.05~1.07，

0.001

]

、双踝距[23.00(18.00~30.00)mm；

=0.98，95%

：0.96~1.00，

=0.078

]

、性别[男性299(46.72%)；

=0.70，95%

：0.46~1.06，

=0.089

]

的预测模型，模型预测下肢力线不良的受试者操作曲线下面积(area under the subject curve，AUC)在训练集和验证集中分别为0.808、0.770。

结论

基于体表大数据，初步构建我国中青年下肢力线不良预测模型，其对于下肢力线不良的诊断效能较高。

Abstract

Objective

To construct a prediction model for coronal malalignment of lower limb in middle-aged and young people in China based on body surface big data in order to provide a faster and more accurate tool for predicting the malalignment in clinical practice.

Methods

A cross-sectional trial was adopted on 915 patients with knee meniscus tears admitted to the Sports Medical Center of our hospital from May 2022 to December 2023. The coronal force line of lower limb was measured

and according to the lower limb force line grading standards

the patients were divided into neutral force line group and malalignment lower limb group

and assigned randomly into training set and validation set in a ratio of 7∶3. Seven indicators

such as gender

age

and body surface big data (including BMI

lower limb length

distance between both knee joints

distance between both ankle joints

and subcutaneous fat thickness) were used to analyze the training set to predict the value of malalignment force line. Logistic regression model and nomogram model were constructed to visualize our prediction model. Then calibration curves

receiver operating characteristic (ROC) curve

and decision curve analysis (DCA) were applied to evaluate the diagnostic efficacy of the constructed model.

Results

In the training set of 640 cases

there were 299 males and 341 females

with a median age of 41.5 years old

and for the validation set

there are 275 patients

including 128 males and 147 females

with a median age of 41.0 years old. Significant differences were observed in above mentioned 7 indicators between the 2 groups in the training set (

0.01). Based on the results of multiple logistic regression analysis

a prediction model for malalignment of lower limb was constructed

including BMI (24.31±3.58 kg/m

=1.12

95%

: 1.06~1.19

0.001)

lower limb length [82.00 (78.00~87.00) cm

=0.95

95%

: 0.92~0.98

=0.002

]

distance between both knee joints [30.00 (16.00~45.25) cm

=1.06

95%

: 1.05~1.07

0.001

]

distance between both ankle joint [23.00 (8.00~30.00) mm

=0.98

95%

: 0.96~1.00

=0.078

]

and gender [man 299 (46.72%)

=0.70

95%

: 0.46~1.06

=0.089

]

. The area under the subject curve (AUC) value of our constructed model for predicting malalignment of lower limb was 0.808 and 0.770

respectively

in the training and validation sets.

Conclusion

Based on body surface big data

we primarily construct a prediction model for malalignment of lower limb for middle-aged and young people in China

which shows a good diagnostic performance on malalignment of lower limb.

关键词

Keywords

references

许涛, 周游. 下肢力线与内侧半月板损伤修复新进展[J]. 中国骨伤, 2022, 35(6): 595-600. DOI: 10.12200/j.issn.1003-0034.2022.06.018.

XU T, ZHOU Y. Recent research on relationship of lower limb alignment and repairment of medial meniscus injury[J]. China J Orthop Traumatol, 2022, 35(6): 595-600. DOI: 10.12200/j.issn.1003-0034.2022.06.018.

傅德杰, 杨柳, 郭林. 半月板损伤与下肢力线[J]. 中国矫形外科杂志, 2021, 29(4): 330-333. DOI: 10.3977/j.issn.1005-8478.2021.04.10.

FU D J, YANG L, GUO L. Meniscus injury and alignment of the lower extremity[J]. Orthop J China, 2021, 29(4): 330-333. DOI: 10.3977/j.issn.1005-8478.2021.04.10.

韩学全, 严孟宁. 膝关节骨关节炎中下肢力线对软骨下小梁骨异常骨重建和软骨退变的影响[J]. 医用生物力学, 2021, 36(S1): 32.

HAN X Q, YAN M N. Effect of lower limb force line on abnormal bone remodeling and cartilage degeneration of subchondral trabecular bone in knee osteoarthritis[J]. J Med Biomech, 2021, 36(S1): 32.

安丙辰, 戴尅戎. 影响膝骨关节炎发病及进展的生物力学因素[J]. 国际骨科学杂志, 2012, 33(3): 153-156. DOI: 10.3969/j.issn.1673-7083.2012.03.001.

AN B C, DAI K R. Biomechanical factors affecting the onset and progress of knee osteoarthritis[J]. Int J Orthop, 2012, 33(3): 153-156. DOI: 10.3969/j.issn.1673-7083.2012.03.001.

史秀明. 负重位下肢全长的摄影体会[J]. 临床军医杂志, 2013, 41(1): 34. DOI: 10.3969/j.issn.1671-3826.2013.01.017.

SHI X M. Photography experience of full length of lower limbs in weight-bearing position[J]. Clin J Med Off, 2013, 41(1): 34. DOI: 10.3969/j.issn.1671-3826.2013.01.017.

田爱洁. 下肢全长负重位X线片的投照技术及临床意义[J]. 解放军预防医学杂志, 2016, 34(S2): 246. DOI: 10.13704/j.cnki.jyyx.2016.s2.224.

TIAN A J. Projectiontechnique and clinical significance of full-length weight-bearing X-ray film of lower limbs[J]. J Prev Med Chin PLA, 2016, 34(S2): 246. DOI: 10.13704/j.cnki.jyyx.2016.s2.224.

李琦, 段王平, 曹晓明, 等. 膝骨关节炎患者体重指数与下肢力线关系的病例对照研究[J]. 中国骨伤, 2011, 24(11): 911-914. DOI: 10.3969/j.issn.1003-0034.2011.11.009.

LI Q, DUAN W P, CAO X M, et al . Case-control study on the relationship between body mass index and lower limb alignment of patients with knee osteoarthritis[J ] . China J Orthop Traumatol, 2011, 24(11): 911-914. DOI: 10.3969/j.issn.1003-0034.2011.11.009.

张子健, 马剑雄, 柏豪豪, 等. 基于深度学习构建模型识别下肢全长正位X线片中的下肢力线关键点及自动测量关键角度[J]. 中国医学影像技术, 2022, 38(6): 901-906. DOI: 10.13929/j.issn.1003-3289.2022.06.025.

ZHANG Z J, MA J X, BAI H H, et al . Automatic measurement model for recognizing key points and automatic measurement of key angles of lower limb alignment on anteroposterior full-length lower limb radiograms based on deep learning[J ] . Chin J Med Imag Technol, 2022, 38(6): 901-906. DOI: 10.13929/j.issn.1003-3289.2022.06.025.

刘力铭, 雷凯, 范华全, 等. 股骨颈干角在前后位X线平片与CT三维重建图像上的差异性研究[J]. 第三军医大学学报, 2020, 42(21): 2134-2140. DOI: 10.16016/j.1000-5404.202006166.

LIU L M, LEI K, FAN H Q, et al . Differences in femoral neck shaft angles between anteroposterior X-ray and 3-dimensional CT reconstruction images: report of 265 cases[J ] . J Third Mil Med Univ, 2020, 42(21): 2134-2140. DOI: 10.16016/j.1000-5404.202006166.

雪合热提·伊纳也提, 刘漪, 甫拉提·吐尔逊. 乌鲁木齐市不同民族儿童皮下脂肪厚度调查[J]. 新疆医科大学学报, 2003, 26(3): 265-267. DOI: 10.3969/j.issn.1009-5551.2003.03.025.

XUEHERETI, LIU Y, POLAT. An investigation of the subcutaneous fat thickness of Uygur, Kazak, Han and Hui children in Urumqi city[J]. J Xinjiang Med Univ, 2003, 26(3): 265-267. DOI: 10.3969/j.issn.1009-5551.2003.03.025.

陈晨. 学生皮下脂肪率与体质健康的生物学研究[J]. 赤峰学院学报(自然科学版), 2021, 37(6): 76-79. DOI: 10.13398/j.cnki.issn1673-260x.2021.06.016.

CHEN C. Biological study on subcutaneous fat rate and physical health of students[J]. J Chifeng Univ Nat Sci Ed, 2021, 37(6): 76-79. DOI: 10.13398/j.cnki.issn1673-260x.2021.06.016.

林惠英. 大学生皮脂厚度测量及其身体成分的分析[J]. 通化师范学院学报, 2004, 25(4): 73-76, 107. DOI: 10.3969/j.issn.1008-7974.2004.04.029.

LIN H Y. Measurement of sebum thickness and analysis of body composition of college students[J]. J Tonghua Norm Univ, 2004, 25(4): 73-76, 107. DOI: 10.3969/j.issn.1008-7974.2004.04.029.

梁永芳, 陈家珠, 闻心培, 等. 贵阳地区1070例健康成人肱三头肌皮脂厚度与臂肌围测定报告[J]. 贵阳医学院学报, 1988(3): 366-369. DOI: 10.19367/j.cnki.1000-2707.1988.03.013.

LIANG Y F, CHEN J Z, WEN X P, et al . Survey on triceps skinnfold thickness(tst)and midarm muscle circumference(mamc)of 1070 healthy adults in Guiyang Area[J ] . J Guiyang Med Coll, 1988(3): 366-369. DOI: 10.19367/j.cnki.1000-2707.1988.03.013.

鲁洋, 郑占乐, 吕骥, 等. 膝内翻患者股骨形态的影像学测量及临床意义的初步研究[J]. 河北医科大学学报, 2018, 39(4): 466-468. DOI: 10.3969/j.issn.1007-3205.2018.04.023.

LU Y, ZHENG Z L, LYU J, et al . Preliminary study on imaging measurement and clinical significance of femoral morphology in patients with knee inversion[J ] . J Hebei Med Univ, 2018, 39(4): 466-468. DOI: 10.3969/j.issn.1007-3205.2018.04.023.

米尔阿里木·木尔提扎, 艾尼瓦尔江·达毛拉, 蔺海山, 等. 全膝关节置换后冠状位股骨-胫骨机械轴偏移与早期关节功能恢复的关系[J]. 中国组织工程研究, 2021, 25(21): 3300-3304. DOI: 10.3969/j.issn.2095-4344.3857.

MUERTIZHA M, DAMAOLA A, LIN H S, et al . Relationship between tibio-femoral mechanical axis deviation on coronal plane and early joint function recovery after total knee arthroplasty[J ] . Chin J Tissue Eng Res, 2021, 25(21): 3300-3304. DOI: 10.3969/j.issn.2095-4344.3857.

KIKUCHI K, NAKANO N, ISHIDA K, et al . Influence of distal reference point of the tibial mechanical axis on the ankle and hindlimb alignment change after total knee arthroplasty[J ] . J Knee Surg. 2023, 3. DOI: 10.1055/s-0043-1774797.

XIE K, HAN X, JIANG X, et al . The fibular shaft axis and medial cortex of the proximal fibula are reliable landmarks for the mechanical axis of the tibia in patients with knee osteoarthritis[J ] . Knee, 2019, 26(6): 1386-1394. DOI: 10.1016/j.knee.2019.08.007.

唐金龙, 杨冠杰, 刘磊, 等. 全膝关节置换后双下肢长度及相关功能变化[J]. 中国组织工程研究, 2020, 24(15): 2310-2316. DOI: 10.3969/j.issn.2095-4344.2585.

TANG J L, YANG G J, LIU L, et al . Change of related functions and double lower limb length after total knee arthroplasty[J ] . Chin J Tissue Eng Res, 2020, 24(15): 2310-2316. DOI: 10.3969/j.issn.2095-4344.2585.

唐承杰, 贾军锋, 张挥武. 基于CT数据的三维重建技术测量膝骨关节炎患者下肢力线及3D打印导板技术在膝关节置换中的应用研究[J]. 中华骨与关节外科杂志, 2022, 15(12): 932-938. DOI: 10.3969/j.issn.2095-9958.2022.12.07.

TANG C J, JIA J F, ZHANG H W. Three-dimensional reconstruction technology based on CT data to measure lower limb alignment in patients with knee osteoarthritis and the application of 3D printing guide plate technology in total knee arthroplasty[J]. Chin J Bone Jt Surg, 2022, 15(12): 932-938. DOI: 10.3969/j.issn.2095-9958.2022.12.07.

ZHANG Y Z, LU S, ZHANG H Q, et al . Alignment of the lower extremity mechanical axis by computer-aided design and application in total knee arthroplasty[J ] . Int J Comput Assist Radiol Surg, 2016, 11(10): 1881-1890. DOI: 10.1007/s11548-016-1382-7.

李思宁, 王直兵, 程兴旺, 等. 残留轻度内翻不影响弓形股骨膝内翻膝关节置换的临床效果[J]. 第三军医大学学报, 2021, 43(22): 2462-2467. DOI: 10.16016/j.1000-5404.202105076.

LI S N, WANG Z B, CHENG X W, et al . Slight varus malalignment has no influence on clinical function in patients with femoral lateral bowing after total knee replacement[J ] . J Third Mil Med Univ, 2021, 43(22): 2462-2467. DOI: 10.16016/j.1000-5404.202105076.

钟昌恒, 江宜松, 刘子林, 等. 膝内翻患者全膝关节置换术后保留轻度内翻对临床效果的影响[J]. 生物骨科材料与临床研究, 2021, 18(5): 39-42+46. DOI: 10.3969/j.issn.1672-5972.2021.05.009.

ZHONG C H, JIANGY S, LIU Z L, et al . The effect of remaining mild varus after total knee arthroplasty in patients with varus knee[J ] . Orthop Biomech Mater Clin Study, 2021, 18(5): 39-42+46. DOI: 10.3969/j.issn.1672-5972.2021.05.009.

郭新全, 王亦进, 宋作才, 等. 原发膝关节骨关节炎病人全下肢立位力线测量研究[J]. 中国临床医学影像杂志, 2001, 12(2): 126-129. DOI: 10.3969/j.issn.1008-1062.2001.02.018.

GUO X Q, WANG Y J, SONG Z C, et al . Research on the weight transmission line of whole lower extremities in primary osteoarthritis of the knee[J ] . J China Clin Med Imaging, 2001, 12(2): 126-129. DOI: 10.3969/j.issn.1008-1062.2001.02.018.

王飞, 尚剑. 股骨前弓与髓内钉匹配性的研究进展[J]. 中华创伤骨科杂志, 2021, 23(12): 1097-1100. DOI: 10.3760/cma.j.cn115530-20210709-00331.

WANG F, SAHNG J. Research progress concerning match between femoral anterior arch and intramedullary nail[J]. Chin J Orthop Trauma, 2021, 23(12): 1097-1100. DOI: 10.3760/cma.j.cn115530-20210709-00331.

THIESEN D M, PRANGE F, BERGER-GROCH J, et al . Femoral antecurvation—A 3D CT analysis of 1232 adult femurs[J ] . PLoS One. 2018, 9;13(10): e0204961. DOI: 10.1371/journal.pone.0204961.

MARATT J, SCHILLING P L, HOLCOMBE S, et al . Variation in the femoral bow: a novel high-throughput analysis of 3922 femurs on cross-sectional imaging[J ] . J Orthop Trauma, 2014: 28(1): 6-9. DOI: 10.1097/BOT.0b013e31829ff3c9.

乔永涛, 刘惠双, 刘杰. 不同年龄段、性别体检人群人体成分对比分析[J]. 河南医学研究, 2018, 27(23): 4254-4256. DOI: 969/j.issn.1004-437X.2018.23.011.

QIAO Y T, LIU H S, LIU J. Comparative analysis of body composition of physical examination population of different ages and sexes[J]. Henan Med Res, 2018, 27(23): 4254-4256. DOI: 969/j.issn.1004-437X.2018.23.011.

孙小舒, 杨滨, 姚杰, 等. X线片拍摄角度对膝骨关节炎患者下肢力线测量误差的影响[J]. 医用生物力学, 2021, 36(S1): 33.

SUN X S, YANG B, YAO J, et al . Influence of shooting angle of X-ray film on measurement error of lower limb force line in patients with knee osteoarthritis[J ] . J Med Biomech, 2021, 36(S1): 33.

廖煜胜, 彭伟清, 胡栢均. 全膝关节置换术前应用双下肢全长摄影对不同体位下肢负重轴线的影响[J]. 实用医院临床杂志, 2021, 18(1): 171-173. DOI: 10.3969/j.issn.1672-6170.2021.01.048.

LIAO Y S, PENG W Q, HU B J. The effect of full-length photography of both lower extremities applied before total knee ar-throplasty on weight-bearing axial alignment of the lower extremities at different positions[J]. Pract J Clin Med, 2021, 18(1): 171-173. DOI: 10.3969/j.issn.1672-6170.2021.01.048.

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