Neeltje M Trouwborst, Miriam G E Oldhoff, Kaj Ten Duis, Sven H van Helden, Erik Hermans, Ruurd L Jaarsma, Esther M M van Lieshout, Inge H F Reininga, Tjarda N Tromp, Michael H J Verhofstad, Jean-Paul P M de Vries, Mathieu M E Wijffels, Anne M L Meesters, Frank F A IJpma
{"title":"三维骨折评估可以预测髋臼骨折非手术治疗后髋关节的生存。","authors":"Neeltje M Trouwborst, Miriam G E Oldhoff, Kaj Ten Duis, Sven H van Helden, Erik Hermans, Ruurd L Jaarsma, Esther M M van Lieshout, Inge H F Reininga, Tjarda N Tromp, Michael H J Verhofstad, Jean-Paul P M de Vries, Mathieu M E Wijffels, Anne M L Meesters, Frank F A IJpma","doi":"10.1302/0301-620X.107B2.BJJ-2024-0390.R1","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>The aim of the study was to apply 3D measurements for fracture displacement in minimally to moderately displaced acetabular fractures treated nonoperatively, and to evaluate whether this measurement can be used to estimate the likelihood of conversion to total hip arthroplasty (THA) at follow-up.</p><p><strong>Methods: </strong>A multicentre, cross-sectional study was performed on 144 patients who were treated nonoperatively for an acetabular fracture in four level 1 trauma centres between January 2000 and December 2020. For each patient, fracture displacement was measured on CT-based 3D models. The 3D gap area represents fracture displacement (mm<sup>2</sup>) between all fracture fragments. A receiver operating characteristic curve was generated to determine a 3D gap area threshold representing the optimal sensitivity and specificity to predict conversion to THA. Native hip survival was reported using Kaplan-Meier curves. Predictors of conversion to THA were determined using Cox regression analysis.</p><p><strong>Results: </strong>Of 144 patients, 18 (12%) received a THA. The median 3D gap area of the complete study cohort was 692 mm<sup>2</sup> (IQR 216 to 1,400). Native hip survival in patients with a gap area threshold ≤ 1,171 or > 1,171 mm<sup>2</sup> differed at one-year (98% vs 85%), two-year (96% vs 77%), and five-year follow-up (92% vs 73%). 3D gap area > 1,171 mm<sup>2</sup> (hazard ratio (HR) 4.3; 95% CI 1.7 to 11.0) and the presence of osteoarthritis grade 2 or higher (HR 3.1; 95% CI 1.2 to 7.8) independently predicted the likelihood of conversion to THA during follow-up.</p><p><strong>Conclusion: </strong>For nonoperatively treated acetabular fractures, introducing 3D gap area assessment to measure fracture displacement offers a promising approach for assessing the risk of conversion to THA. With the introduction of (semi-)automatic segmentation and measurement techniques, or their implementation into commercially available software, this 3D gap area measurement can serve as an addition to the Letournel classification and an alternative to traditional 2D gap and step-off measurements, improving accuracy, reproducibility, and applicability in clinical decision-making.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"204-212"},"PeriodicalIF":4.9000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"3D fracture assessment could be predictive of native hip survival after nonoperative treatment of acetabular fractures.\",\"authors\":\"Neeltje M Trouwborst, Miriam G E Oldhoff, Kaj Ten Duis, Sven H van Helden, Erik Hermans, Ruurd L Jaarsma, Esther M M van Lieshout, Inge H F Reininga, Tjarda N Tromp, Michael H J Verhofstad, Jean-Paul P M de Vries, Mathieu M E Wijffels, Anne M L Meesters, Frank F A IJpma\",\"doi\":\"10.1302/0301-620X.107B2.BJJ-2024-0390.R1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>The aim of the study was to apply 3D measurements for fracture displacement in minimally to moderately displaced acetabular fractures treated nonoperatively, and to evaluate whether this measurement can be used to estimate the likelihood of conversion to total hip arthroplasty (THA) at follow-up.</p><p><strong>Methods: </strong>A multicentre, cross-sectional study was performed on 144 patients who were treated nonoperatively for an acetabular fracture in four level 1 trauma centres between January 2000 and December 2020. For each patient, fracture displacement was measured on CT-based 3D models. The 3D gap area represents fracture displacement (mm<sup>2</sup>) between all fracture fragments. A receiver operating characteristic curve was generated to determine a 3D gap area threshold representing the optimal sensitivity and specificity to predict conversion to THA. Native hip survival was reported using Kaplan-Meier curves. Predictors of conversion to THA were determined using Cox regression analysis.</p><p><strong>Results: </strong>Of 144 patients, 18 (12%) received a THA. The median 3D gap area of the complete study cohort was 692 mm<sup>2</sup> (IQR 216 to 1,400). Native hip survival in patients with a gap area threshold ≤ 1,171 or > 1,171 mm<sup>2</sup> differed at one-year (98% vs 85%), two-year (96% vs 77%), and five-year follow-up (92% vs 73%). 3D gap area > 1,171 mm<sup>2</sup> (hazard ratio (HR) 4.3; 95% CI 1.7 to 11.0) and the presence of osteoarthritis grade 2 or higher (HR 3.1; 95% CI 1.2 to 7.8) independently predicted the likelihood of conversion to THA during follow-up.</p><p><strong>Conclusion: </strong>For nonoperatively treated acetabular fractures, introducing 3D gap area assessment to measure fracture displacement offers a promising approach for assessing the risk of conversion to THA. With the introduction of (semi-)automatic segmentation and measurement techniques, or their implementation into commercially available software, this 3D gap area measurement can serve as an addition to the Letournel classification and an alternative to traditional 2D gap and step-off measurements, improving accuracy, reproducibility, and applicability in clinical decision-making.</p>\",\"PeriodicalId\":48944,\"journal\":{\"name\":\"Bone & Joint Journal\",\"volume\":\"107-B 2\",\"pages\":\"204-212\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Bone & Joint Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0390.R1\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone & Joint Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0390.R1","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：本研究的目的是应用3D测量非手术治疗的髋臼骨折的骨折位移，并评估该测量是否可用于评估随访时转全髋关节置换术（THA）的可能性。方法：对2000年1月至2020年12月期间在4个一级创伤中心接受非手术治疗的144例髋臼骨折患者进行多中心横断面研究。对于每位患者，通过基于ct的3D模型测量骨折位移。三维间隙面积表示所有裂缝碎片之间的裂缝位移（mm2）。生成接受者工作特性曲线，以确定代表预测THA转换的最佳灵敏度和特异性的3D间隙区域阈值。用Kaplan-Meier曲线报道髋关节自然生存率。采用Cox回归分析确定THA转化的预测因子。结果：144例患者中，18例（12%）接受了THA。整个研究队列的中位三维间隙面积为692 mm2 （IQR 216至1400）。间隙面积阈值≤1171或bbb10 1171 mm2的患者的原生髋关节生存率在1年（98% vs 85%）、2年（96% vs 77%）和5年随访（92% vs 73%）时存在差异。三维间隙面积bbb10 1,171 mm2(风险比（HR） 4.3；95% CI 1.7 - 11.0)和存在2级或更高级别骨关节炎(HR 3.1；95% CI 1.2 ~ 7.8)独立预测随访期间转为THA的可能性。结论：对于非手术治疗的髋臼骨折，引入三维间隙面积评估来测量骨折位移是评估髋臼置换风险的一种很有前景的方法。随着（半）自动分割和测量技术的引入，或将其应用于商用软件中，这种3D间隙面积测量可以作为Letournel分类的补充，也可以替代传统的2D间隙和步进测量，从而提高准确性、可重复性和临床决策的适用性。
3D fracture assessment could be predictive of native hip survival after nonoperative treatment of acetabular fractures.
Aims: The aim of the study was to apply 3D measurements for fracture displacement in minimally to moderately displaced acetabular fractures treated nonoperatively, and to evaluate whether this measurement can be used to estimate the likelihood of conversion to total hip arthroplasty (THA) at follow-up.
Methods: A multicentre, cross-sectional study was performed on 144 patients who were treated nonoperatively for an acetabular fracture in four level 1 trauma centres between January 2000 and December 2020. For each patient, fracture displacement was measured on CT-based 3D models. The 3D gap area represents fracture displacement (mm2) between all fracture fragments. A receiver operating characteristic curve was generated to determine a 3D gap area threshold representing the optimal sensitivity and specificity to predict conversion to THA. Native hip survival was reported using Kaplan-Meier curves. Predictors of conversion to THA were determined using Cox regression analysis.
Results: Of 144 patients, 18 (12%) received a THA. The median 3D gap area of the complete study cohort was 692 mm2 (IQR 216 to 1,400). Native hip survival in patients with a gap area threshold ≤ 1,171 or > 1,171 mm2 differed at one-year (98% vs 85%), two-year (96% vs 77%), and five-year follow-up (92% vs 73%). 3D gap area > 1,171 mm2 (hazard ratio (HR) 4.3; 95% CI 1.7 to 11.0) and the presence of osteoarthritis grade 2 or higher (HR 3.1; 95% CI 1.2 to 7.8) independently predicted the likelihood of conversion to THA during follow-up.
Conclusion: For nonoperatively treated acetabular fractures, introducing 3D gap area assessment to measure fracture displacement offers a promising approach for assessing the risk of conversion to THA. With the introduction of (semi-)automatic segmentation and measurement techniques, or their implementation into commercially available software, this 3D gap area measurement can serve as an addition to the Letournel classification and an alternative to traditional 2D gap and step-off measurements, improving accuracy, reproducibility, and applicability in clinical decision-making.
期刊介绍：
We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
