计算机断层扫描成像的三维重建在评估股骨髋臼撞击症患者髋臼边缘骨质增生或髋臼边缘病变方面并不可靠

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-02-09 DOI:10.1016/j.asmr.2024.100892

Hanmei Dong M.D. , Maihemuti Maimaitimin M.D. , Chenbo Jiao , Yuhao Liu , Guanying Gao M.D. , Tongchuan He M.D. Ph, D. , Yan Xu M.D.

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The ARO was evaluated both on the acetabular gross anatomy (AGA) and coronal sections of CT, for its position, width (unit: mm), area (unit: mm<sup>2</sup>), and CT value (unit: HU). Patients were divided into 4 groups based on the extent of ARO on coronal CT: group A (ARO anterior to 12 o’clock), group P (ARO posterior to 12 o’clock), group AP (ARO across 12 o’clock), and group N (no ARO). Inter- and intraobserver correlation was analyzed. Demographic data, FAI deformity indicators on imaging, quantitative measurements of ARO, and pre- and postoperative patient-reported outcomes were compared among groups.</p></div><div><h3>Results</h3><p>There were 229 patients (229 hips) enrolled in total, 122 male (53.3%) and 107 female (46.7%), with a mean age of 37.2 ± 10.2 years. The correlation between 2 observers for grouping ARO using AGA was positive but poor (Kendall Tau-b coefficient = 0.157, <em>P</em> = .008). Moderate correlation was found between grouping based on AGA and coronal CT by the same observer (Kendall Tau-b coefficient = 0.482, <em>P</em> = .000). The patients were divided into 4 groups: 84 patients (36.7%) in group N, 2 patients (0.9%) in group A, 69 patients (30.1%) in group P, and 74 patients (32.3%) in group AP. Group N was younger in age (35.4 ± 10.7 years) than group P (39.6 ± 10.2 years) (<em>P</em> = 0.012) and had a larger proportion of women (57.1%) than group AP (36.5%) (χ<sup>2</sup> = 6.869, <em>P</em> = .032). There was a greater proportion of positive posterior wall sign in group P (52.2%) than 48.6% for group AP and 33.3% for group N (χ<sup>2</sup> = 6.397, <em>P</em> = .041). Group N had 61 (72.6%) Tönnis grade 0 hips compared with 37 (50%) in group AP (<em>P</em> = .014). No statistical significance was found among groups in pre- and postoperative α angle, lateral center-edge angle, and patient-reported outcomes. The widths of ARO in group AP for the 3 marked points from anterior to posterior were 3.88 ± 1.86, 4.84 ± 2.72, and 6.66 ± 3.18, separately (<em>P</em>＜.001); 15.73 ± 21.46, 19.22 ± 18.86, and 29.96 ± 17.05 for area (<em>P</em>＜.01); and 652.67 ± 214.12, 677.10 ± 274.81, and 728.84 ± 232.39 for CT value (<em>P</em>＜.05). For the ARO posterior to 12 o’clock, the group AP showed a larger width (6.66 ± 3.18), area (29.96 ± 17.05), and CT value (728.84 ± 232.39) than group P of (4.70 ± 2.25), (20.15 ± 12.91), and (641.84 ± 183.33) (<em>P</em>＜.001).</p></div><div><h3>Conclusions</h3><p>The evaluation of ARO on AGA is poor consistent with definite double-rim sign on coronal CT. There is a tendency of size-enlarging and density-increasing for ARO from anterior to posterior along the acetabular rim. Younger age, female gender, lower Tönnis grade, and negative posterior wall sign showed lower rate of ARO development.</p></div><div><h3>Level of Evidence</h3><p>Level IV, diagnostic case series.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 2","pages":"Article 100892"},"PeriodicalIF":0.0000,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000105/pdfft?md5=af9a44455e6f0803b785b08afeafc843&pid=1-s2.0-S2666061X24000105-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Three-Dimensional Reconstruction of Computed Tomography Imaging Is Not Reliable in Assessing Acetabular Rim Osteophytes or Acetabular Rim Pathology in Patients With Femoroacetabular Impingement\",\"authors\":\"Hanmei Dong M.D. , Maihemuti Maimaitimin M.D. , Chenbo Jiao , Yuhao Liu , Guanying Gao M.D. , Tongchuan He M.D. Ph, D. , Yan Xu M.D.\",\"doi\":\"10.1016/j.asmr.2024.100892\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>To determine the reliability of 3-dimensional (3D) reconstruction of computed tomography (CT) imaging in evaluating acetabular rim morphology or acetabular rim osteophyte (ARO) existence and to group patients with femoroacetabular impingement (FAI) by ARO extent on coronal sections of CT and further compare clinical differences among groups.</p></div><div><h3>Methods</h3><p>Patients who underwent primary hip arthroscopy for FAI by the same surgeon between August 2016 and December 2018 with minimum 2-year follow-up were enrolled. The ARO was evaluated both on the acetabular gross anatomy (AGA) and coronal sections of CT, for its position, width (unit: mm), area (unit: mm<sup>2</sup>), and CT value (unit: HU). Patients were divided into 4 groups based on the extent of ARO on coronal CT: group A (ARO anterior to 12 o’clock), group P (ARO posterior to 12 o’clock), group AP (ARO across 12 o’clock), and group N (no ARO). Inter- and intraobserver correlation was analyzed. Demographic data, FAI deformity indicators on imaging, quantitative measurements of ARO, and pre- and postoperative patient-reported outcomes were compared among groups.</p></div><div><h3>Results</h3><p>There were 229 patients (229 hips) enrolled in total, 122 male (53.3%) and 107 female (46.7%), with a mean age of 37.2 ± 10.2 years. The correlation between 2 observers for grouping ARO using AGA was positive but poor (Kendall Tau-b coefficient = 0.157, <em>P</em> = .008). Moderate correlation was found between grouping based on AGA and coronal CT by the same observer (Kendall Tau-b coefficient = 0.482, <em>P</em> = .000). The patients were divided into 4 groups: 84 patients (36.7%) in group N, 2 patients (0.9%) in group A, 69 patients (30.1%) in group P, and 74 patients (32.3%) in group AP. Group N was younger in age (35.4 ± 10.7 years) than group P (39.6 ± 10.2 years) (<em>P</em> = 0.012) and had a larger proportion of women (57.1%) than group AP (36.5%) (χ<sup>2</sup> = 6.869, <em>P</em> = .032). There was a greater proportion of positive posterior wall sign in group P (52.2%) than 48.6% for group AP and 33.3% for group N (χ<sup>2</sup> = 6.397, <em>P</em> = .041). Group N had 61 (72.6%) Tönnis grade 0 hips compared with 37 (50%) in group AP (<em>P</em> = .014). No statistical significance was found among groups in pre- and postoperative α angle, lateral center-edge angle, and patient-reported outcomes. 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引用次数: 0

摘要

目的确定计算机断层扫描（CT）成像的三维（3D）重建在评估髋臼边缘形态或髋臼边缘骨质增生（ARO）存在方面的可靠性，并根据CT冠状切片上的ARO范围对股骨髋臼撞击症（FAI）患者进行分组，进一步比较各组之间的临床差异。方法纳入2016年8月至2018年12月期间由同一外科医生接受初级髋关节镜手术治疗FAI且随访至少2年的患者。在髋臼大体解剖（AGA）和 CT 冠状切片上对 ARO 的位置、宽度（单位：mm）、面积（单位：mm2）和 CT 值（单位：HU）进行评估。根据冠状 CT 上 ARO 的范围将患者分为 4 组：A 组（ARO 位于 12 点钟方向前方）、P 组（ARO 位于 12 点钟方向后方）、AP 组（ARO 穿过 12 点钟方向）和 N 组（无 ARO）。分析了观察者之间和观察者内部的相关性。对各组的人口统计学数据、影像学显示的FAI畸形指标、ARO的定量测量结果以及术前术后患者报告的结果进行了比较。结果共有229名患者（229个髋关节）入组，其中男性122人（53.3%），女性107人（46.7%），平均年龄（37.2±10.2）岁。在使用 AGA 对 ARO 进行分组时，两名观察者之间的相关性为正但较差（Kendall Tau-b coefficient = 0.157，P = .008）。根据 AGA 和同一观察者的冠状 CT 进行分组之间存在中度相关性（Kendall Tau-b coefficient = 0.482，P = .000）。患者被分为 4 组：N 组 84 人（36.7%），A 组 2 人（0.9%），P 组 69 人（30.1%），AP 组 74 人（32.3%）。N 组的年龄（35.4 ± 10.7 岁）小于 P 组（39.6 ± 10.2 岁）（P = 0.012），女性比例（57.1%）大于 AP 组（36.5%）（χ2 = 6.869，P = 0.032）。P 组（52.2%）后壁征阳性的比例高于 AP 组（48.6%）和 N 组（33.3%）（χ2 = 6.397，P = .041）。N 组有 61 个（72.6%）Tönnis 0 级髋关节，而 AP 组有 37 个（50%）（P = .014）。各组在术前、术后α角、外侧中心边缘角和患者报告结果方面均无统计学意义。AP 组从前方到后方 3 个标记点的 ARO 宽度分别为（3.88 ± 1.86）、（4.84 ± 2.72）和（6.66 ± 3.18）（P＜.001）；AP 组从前方到后方 3 个标记点的 ARO 宽度分别为（15.面积分别为 15.73 ± 21.46、19.22 ± 18.86 和 29.96 ± 17.05（P＜.01）；CT 值分别为 652.67 ± 214.12、677.10 ± 274.81 和 728.84 ± 232.39（P＜.05）。对于 12 点钟后方的 ARO，AP 组的宽度（6.66 ± 3.18）、面积（29.96 ± 17.05）和 CT 值（728.84 ± 232.39）均大于 P 组（4.70 ± 2.25）、（20.15 ± 12.91）和（641.84 ± 183.33）（P＜.001）。沿髋臼边缘从前方到后方，ARO 有体积增大和密度增加的趋势。年龄较小、女性、Tönnis分级较低、后壁征阴性的患者发生ARO的比例较低。

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Three-Dimensional Reconstruction of Computed Tomography Imaging Is Not Reliable in Assessing Acetabular Rim Osteophytes or Acetabular Rim Pathology in Patients With Femoroacetabular Impingement

Purpose

To determine the reliability of 3-dimensional (3D) reconstruction of computed tomography (CT) imaging in evaluating acetabular rim morphology or acetabular rim osteophyte (ARO) existence and to group patients with femoroacetabular impingement (FAI) by ARO extent on coronal sections of CT and further compare clinical differences among groups.

Methods

Patients who underwent primary hip arthroscopy for FAI by the same surgeon between August 2016 and December 2018 with minimum 2-year follow-up were enrolled. The ARO was evaluated both on the acetabular gross anatomy (AGA) and coronal sections of CT, for its position, width (unit: mm), area (unit: mm²), and CT value (unit: HU). Patients were divided into 4 groups based on the extent of ARO on coronal CT: group A (ARO anterior to 12 o’clock), group P (ARO posterior to 12 o’clock), group AP (ARO across 12 o’clock), and group N (no ARO). Inter- and intraobserver correlation was analyzed. Demographic data, FAI deformity indicators on imaging, quantitative measurements of ARO, and pre- and postoperative patient-reported outcomes were compared among groups.

Results

There were 229 patients (229 hips) enrolled in total, 122 male (53.3%) and 107 female (46.7%), with a mean age of 37.2 ± 10.2 years. The correlation between 2 observers for grouping ARO using AGA was positive but poor (Kendall Tau-b coefficient = 0.157, P = .008). Moderate correlation was found between grouping based on AGA and coronal CT by the same observer (Kendall Tau-b coefficient = 0.482, P = .000). The patients were divided into 4 groups: 84 patients (36.7%) in group N, 2 patients (0.9%) in group A, 69 patients (30.1%) in group P, and 74 patients (32.3%) in group AP. Group N was younger in age (35.4 ± 10.7 years) than group P (39.6 ± 10.2 years) (P = 0.012) and had a larger proportion of women (57.1%) than group AP (36.5%) (χ² = 6.869, P = .032). There was a greater proportion of positive posterior wall sign in group P (52.2%) than 48.6% for group AP and 33.3% for group N (χ² = 6.397, P = .041). Group N had 61 (72.6%) Tönnis grade 0 hips compared with 37 (50%) in group AP (P = .014). No statistical significance was found among groups in pre- and postoperative α angle, lateral center-edge angle, and patient-reported outcomes. The widths of ARO in group AP for the 3 marked points from anterior to posterior were 3.88 ± 1.86, 4.84 ± 2.72, and 6.66 ± 3.18, separately (P＜.001); 15.73 ± 21.46, 19.22 ± 18.86, and 29.96 ± 17.05 for area (P＜.01); and 652.67 ± 214.12, 677.10 ± 274.81, and 728.84 ± 232.39 for CT value (P＜.05). For the ARO posterior to 12 o’clock, the group AP showed a larger width (6.66 ± 3.18), area (29.96 ± 17.05), and CT value (728.84 ± 232.39) than group P of (4.70 ± 2.25), (20.15 ± 12.91), and (641.84 ± 183.33) (P＜.001).

Conclusions

The evaluation of ARO on AGA is poor consistent with definite double-rim sign on coronal CT. There is a tendency of size-enlarging and density-increasing for ARO from anterior to posterior along the acetabular rim. Younger age, female gender, lower Tönnis grade, and negative posterior wall sign showed lower rate of ARO development.