关节间隙的影像学评估能否准确预测髋关节镜下滑膜切除术后软骨损伤？一项横断面分析
Can Radiographic Joint Space Accurately Predict Chondral Damage During Hip Arthroscopy? A Cross-Sectional Analysis.
机构信息
American Hip Institute Research Foundation, Des Plaines, Illinois, U.S.A.
American Hip Institute Research Foundation, Des Plaines, Illinois, U.S.A.; American Hip Institute, Des Plaines, Illinois, U.S.A.
出版信息
Arthroscopy. 2020 Jun;36(6):1565-1572.e1. doi: 10.1016/j.arthro.2020.01.034. Epub 2020 Feb 5.
PURPOSE
To examine how preoperative radiographic joint space correlated with intraoperative chondral damage as diagnosed during hip arthroscopy, in patients without radiographic evidence of osteoarthritis or joint space <2 mm.
METHODS
Patients younger than the age of 50 years without previous hip conditions who underwent hip primary arthroscopy had their joint space and intraoperative chondral damage compared. A narrow joint space group was defined as those in the lowest decile of the average joint space. The demographics and presence of intra-articular findings of chondral damage were compared. In addition, receiver operator characteristic (ROC) curves were used to assess joint space as a predictor of intraarticular damage.
RESULTS
There were 1892 in this analysis. The incidence of severe cartilage damage (Outerbridge III and IV) was not significantly different between the narrow and non-narrow groups. The ROC analysis for joint space at detecting chondral damage was poor. The ROC area under the curve for joint space detecting any chondral defect (acetabular or femoral head) was 0.536 (confidence interval 0.506-0.565), with low sensitivity (0.492), specificity (0.582), negative predictive value (0.720), and positive predictive value (0.340). Spearman correlation could not demonstrate a correlation between joint space and cartilage damage (⍴ = 0.10, ⍴ = 0.04). Interestingly, a gradual widening was observed between the medial and lateral joint spaces, with more pronounced findings in hips without damage.
CONCLUSIONS
The results of this study demonstrate that in patients with Tönnis 0 and 1, narrower joint space may be an anatomic variant and cannot predict actual intraoperative cartilage damage. However, if the lateral joint space has relative narrowing compared with the medial joint space, this may indicate acetabular cartilage damage.
LEVEL OF EVIDENCE
III, retrospective diagnostic comparative study.
目的
研究在没有影像学证据表明存在骨关节炎或关节间隙 <2 毫米的情况下，术前放射学关节间隙与髋关节镜检查时诊断的术中软骨损伤之间的相关性。
方法
选择年龄小于 50 岁且无髋关节病史的患者，对其行髋关节初次关节镜检查，比较关节间隙和术中软骨损伤情况。将关节间隙较窄的患者定义为关节间隙处于最低十分位数的患者。比较两组的一般资料和关节内软骨损伤的存在情况。此外，还使用受试者工作特征（ROC）曲线评估关节间隙作为关节内损伤的预测指标。
结果
本研究共纳入 1892 例患者。在狭窄组和非狭窄组之间，严重软骨损伤（Outerbridge III 和 IV 级）的发生率无显著差异。关节间隙对软骨损伤的 ROC 分析结果不佳。关节间隙检测任何软骨缺陷（髋臼或股骨头）的 ROC 曲线下面积为 0.536（置信区间 0.506-0.565），灵敏度低（0.492），特异性（0.582），阴性预测值（0.720）和阳性预测值（0.340）。Spearman 相关性分析无法显示关节间隙与软骨损伤之间存在相关性（⍴=0.10，⍴=0.04）。有趣的是，在没有损伤的髋关节中，内侧和外侧关节间隙之间观察到逐渐变宽，且发现更为明显。
结论
本研究结果表明，在 Tönnis 0 和 1 型患者中，关节间隙变窄可能是一种解剖学变异，不能预测实际的术中软骨损伤。然而，如果与内侧关节间隙相比，外侧关节间隙相对变窄，则可能表明髋臼软骨损伤。
证据等级
III 级，回顾性诊断比较研究。
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