一种使用普通计算机断层扫描评估髋骨关节炎中臀小肌脂肪浸润的新分类系统。
A new classification system for evaluating fatty infiltration of the gluteus minimus in hip osteoarthritis using plain computed tomography.
机构信息
Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan.
Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan.
出版信息
J Orthop Sci. 2022 Jul;27(4):792-797. doi: 10.1016/j.jos.2021.04.005. Epub 2021 May 24.
BACKGROUND
Fatty infiltration of the gluteus muscles increases due to the presence of hip osteoarthritis (OA); it is often evident in the gluteus minimus. The gluteus minimus acts not only as an abductor and rotator but also helps stabilize the femur's head. Moreover, the atrophy or fatty infiltration of the gluteus minimus leads to an increased risk of fall and fracture. Until now, fatty infiltration of this muscle has often been evaluated using magnetic resonance imaging using the Goutallier classification system, originally developed for the rotator cuff. However, the accessibility of magnetic resonance imaging remains problematic, and the reliability of the classification has room for improvement. Thus, this study aimed to devise a new classification system for the fatty infiltration of the gluteus minimus using plain computed tomography (CT).
METHODS
We retrospectively reviewed 71 patients (141 hips) who underwent unilateral total hip arthroplasty for hip OA. To assess the system's reliability, three doctors classified the fatty infiltration of the gluteus minimus based on the CT images of 20 hips randomly selected from the study participants using both the Goutallier and the new classification systems. Then, we selected 113 hips with Crowe type 1 and evaluated them using the new classification system to assess the association between the extent of fatty infiltration and the severity of hip OA.
RESULTS
Both classifications had good intra- and inter-observer reliability. The kappa values of the new classification system (0.83-0.95) were higher than that of the Goutallier classification system (0.72-0.87). The Jonckheere-Terpstra test showed that the degree of fatty infiltration of the gluteus minimus according to the new system progressed incrementally with the progression of hip OA (p = 0.016).
CONCLUSIONS
The new classification system can be recommended for clinical use.
背景
髋关节骨关节炎（OA）的存在会导致臀肌脂肪浸润增加；这种情况在臀小肌中尤为明显。臀小肌不仅作为外展肌和旋转肌发挥作用，还有助于稳定股骨头部。此外，臀小肌的萎缩或脂肪浸润会增加跌倒和骨折的风险。到目前为止，该肌肉的脂肪浸润通常使用磁共振成像（MRI）使用最初为肩袖开发的 Goutallier 分类系统进行评估。然而，MRI 的可及性仍然存在问题，并且分类的可靠性仍有改进的空间。因此，本研究旨在使用普通计算机断层扫描（CT）为臀小肌的脂肪浸润设计一种新的分类系统。
方法
我们回顾性分析了 71 例（141 髋）因髋 OA 行单侧全髋关节置换术的患者。为了评估该系统的可靠性，三位医生根据从研究参与者中随机选择的 20 髋的 CT 图像，使用 Goutallier 和新分类系统对臀小肌的脂肪浸润进行分类。然后，我们选择了 113 例 Crowe 1 型髋，使用新分类系统评估脂肪浸润程度与髋 OA 严重程度之间的关系。
结果
两种分类均具有良好的内部和观察者间可靠性。新分类系统的kappa 值（0.83-0.95）高于 Goutallier 分类系统（0.72-0.87）。Jonckheere-Terpstra 检验显示，根据新系统，臀小肌的脂肪浸润程度随着髋 OA 的进展逐渐递增（p=0.016）。
结论
新的分类系统可推荐用于临床应用。
Zotero 插件