Mary Jiayi Tao, Linda Probyn, Michael Poon, Hans Kreder, Markku Nousiainen, Richard Jenkinson, Bo Angela Wan, May Tsao, Elizabeth Barnes, Edward Chow
1 Department of Radiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
2 Department of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Br J Radiol. 2017 Dec;90(1080):20170263. doi: 10.1259/bjr.20170263. Epub 2017 Oct 3.
The Brooker classification is a commonly used tool to characterize the extent of heterotopic ossification (HTO), which is the dystrophic formation of mature lamellar bone in non-osseous tissues such as muscles, connective tissue or nerves. We aim to provide illustrative cases to describe the limitations and challenges of this system.
A retrospective review was conducted in all patients who had retrieved hip and/or pelvic radiotherapy for HTO prophylaxis at Sunnybrook Health Sciences Centre between July 1998 and August 2016. An independent musculoskeletal radiologist who was blinded to the condition of the patient and the clinical outcome evaluated the imaging studies based on the Brooker classification.
22 patients were identified for analysis. Three patient cases were presented to illustrate the discrepancies between the Brooker classification and radiographic images, CT images and different radiographical projections. Two patient cases were presented to demonstrate the inability of the Brooker classification to account for volumetric differences in HTO and arthroplasty lengths.
Although the Brooker classification for HTO is a widely used quantitative and qualitative assessment tool given its simplicity and familiarity, it possesses several limitations. Utilization of other radiographic modalities, such as CT, and orthogonal projections may reduce ambiguities from using the HTO system. Development of a classification method that can appropriately correspond to the clinical outcomes such as functional capabilities to further HTO development is warranted. Advances in knowledge: The present study critically evaluated the Brooker classification system, and identified areas in which improvement is warranted on characterizing HTO. This is important in further research that aims to improve the accuracy of HTO classification guidelines.
布鲁克分类法是一种常用的工具，用于描述异位骨化（HTO）的程度，异位骨化是指在肌肉、结缔组织或神经等非骨组织中形成成熟板层骨的营养不良性骨化。我们旨在通过实例来说明该系统的局限性和挑战。
对1998年7月至2016年8月期间在桑尼布鲁克健康科学中心接受髋关节和/或骨盆放疗以预防HTO的所有患者进行回顾性研究。一名对患者病情和临床结果不知情的独立肌肉骨骼放射科医生根据布鲁克分类法对影像学研究进行评估。
确定了22例患者进行分析。展示了3例患者的病例，以说明布鲁克分类法与X线图像、CT图像及不同X线投照之间的差异。展示了2例患者的病例，以证明布鲁克分类法无法解释HTO的体积差异和关节成形术长度。
尽管布鲁克HTO分类法因其简单易懂而被广泛使用，是一种定量和定性的评估工具，但它存在一些局限性。使用其他影像学检查方法，如CT和正交投照，可能会减少使用HTO系统时的模糊性。有必要开发一种能够与功能能力等临床结果适当对应的分类方法，以进一步研究HTO的发展。知识进展：本研究对布鲁克分类系统进行了批判性评估，并确定了在HTO特征描述方面需要改进的领域。这对于旨在提高HTO分类指南准确性的进一步研究很重要。
