用于估测皮质-钙化边界的新影像学发现：股骨髋臼撞击症患者的磁共振成像病例系列

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2024-10-18 DOI:10.1016/j.jor.2024.10.001

Madeleine G. DeClercq , Rui W. Soares , Adam M. Johannsen , Toufic R. Jildeh , Lauren A. Pierpoint , Carly A. Lockard , Maitland D. Martin , Marc J. Philippon

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引用次数: 0

摘要

目的通过比较磁共振成像（MRI）上皮质外缘（术前α角）和皮质内缘（术后理论α角）的α角测量值，确定是否能估算出有症状的股骨髋臼撞击症（FAI）患者需要切除多少硬化骨才能将α角恢复到正常值（55⁰）。方法对 2013 年 6 月至 2017 年 2 月期间接受初级髋关节镜手术和 CAM 骨整形术的 FAI 患者进行回顾性研究。纳入标准为放射医师在 3T 斜轴磁共振成像上测量的α角>70°、单侧原发性髋关节镜检查、年龄≥18 岁。排除标准包括既往髋关节手术、髋关节创伤、血管性坏死、晚期骨关节炎、发育不良、图像质量差或缺失 MRI 图像。术前使用股骨外侧皮质边缘测量阿尔法角，术后使用股骨内侧皮质边缘测量阿尔法角。手术由资深外科医生进行。用配对t检验比较术前和术后的α角，并用类内相关系数（ICC）评估评分者之间和评分者内部的可靠性。结果 100名患者（100个髋关节）的平均年龄为40.8岁（18.7-64.9岁），75%为男性（n = 75）。平均体重指数为 24.7 ± 3.9（范围为 17.1-38.8）。皮质外缘的平均最大α角为 77.0 ± 4.2°（范围为 70.0-90.8），评分者间可靠性的 ICC 为 0.861，表明一致性极佳。皮质内α角的平均值为 46.4 ± 3.4°（范围为 36.5-55.4），明显小于 55°（p<0.001）。结论 MRI 外部和内部皮质阿尔法角之间的差异可准确估计出 FAI 患者为将阿尔法角恢复到正常值所需的硬化骨切除量。这一信息可直接应用于临床标记，以评估CAM切除的充分性。

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A novel radiographic finding for estimation of the cortical-cancellous boundary: A magnetic resonance imaging case series of patients with femoroacetabular impingement

Purpose

To determine if comparing alpha angle measurements of the outer cortical margin (preoperative alpha angle) and the inner cortical margin (theoretical postoperative alpha angle) on magnetic resonance imaging (MRI) can estimate the amount of sclerotic bone that needs to be resected to restore the alpha angle to normative values (<55⁰) in patients with symptomatic femoroacetabular impingement (FAI).

Methods

A retrospective review was conducted on patients with FAI undergoing primary hip arthroscopy and CAM osteoplasty from June 2013 to February 2017. Inclusion criteria were radiologist-measured alpha angles >70° on 3T oblique axial MRI, unilateral primary hip arthroscopy, and age ≥18. Exclusions included previous hip surgery, hip trauma, avascular necrosis, advanced osteoarthritis, dysplasia, poor quality images, or missing MRI images. Alpha angles were measured preoperatively using the outer cortical margin and postoperatively using the inner cortical margin of femur. Surgeries were performed by the senior surgeon. Paired t-tests compared preoperative and postoperative alpha angles, and intraclass correlation coefficients (ICC) were used to assess inter-rater and intra-rater reliability.

Results

One hundred patients (100 hips) were included with an average age of 40.8 years (range, 18.7–64.9), with 75 % being male (n = 75). The average BMI was 24.7 ± 3.9 (range, 17.1–38.8). The average maximum alpha angle at the outer cortical margin was 77.0 ± 4.2° (range, 70.0–90.8), with an ICC for inter-rater reliability of 0.861, indicating excellent agreement. The average inner cortical alpha angle was 46.4 ± 3.4° (range, 36.5–55.4), significantly less than 55° (p<0.001). The mean difference between the outer and inner cortical alpha angles was −30.6 ± 5.1° (p< 0.001).

Conclusions

The difference between outer and inner cortical alpha angles on MRI can accurately estimate the amount of sclerotic bone resection needed to restore the alpha angle to normative values in patients with FAI. This information may be directly applied clinically marker to assess adequacy of CAM resection.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.