Liu Y, Ma W-J, Huang K, Yang J, Zeng Y, Shen B
Orthopedics Research Institute, Department of Orthopedics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Osteoporos Int. 2022 Apr;33(4):871-879. doi: 10.1007/s00198-021-06231-8. Epub 2021 Nov 13.
Using anteroposterior (AP) hip radiograph, we measured several indexes to investigate the association with bone mineral density (BMD) before THA and found a highly effective index to predict femoral BMD. This technique is helpful for both patients and clinicians to identify potential candidates with low BMD to whom DXA examination is particularly recommended.
The purpose of the study is to identify patients with low bone mineral density (BMD) prior to total hip arthroplasty with the help of AP hip radiographs.
Indexes on AP hip radiographs and T-scores from DXA examination of the lumbar spine and the affected hip were acquired from patients before THA. Indexes measured on AP hip radiographs including the canal calcar ratio (CCR), canal flare index (CFI), morphological cortical index (MCI), canal bone ratio (CBR), and canal bone area ratio (CBAR). The relevance between indexes and the T-score of femora was evaluated by correlation analysis, and the diagnostic value of indexes for osteopenia was examined by receiver operating characteristic (ROC) curves.
A total of 81 patients were included. The average value of CBR-7, CBR-10, and CBAR (7-10) were highly related to the T-score of femora (r = - 0.592, r = - 0.634, and r = - 0.631, respectively, p < 0.0001). Results of the intra- and interobserver variation assessment was excellent. CBR-7, CBR-10, and CBAR (7-10) were significantly different between the non-osteopenia and osteopenia groups (p < 0.0001). CBR-10 had the biggest area under curve (AUC), means the great diagnostic value for osteopenia in the proximal femora (AUC = 0.821, cutoff value = 0.3805).
The canal bone ratio at 10 × 10 m under the level of the lesser trochanter proved to be a great indicator of femoral osteopenia. Trial registration Chinese Clinical Trail Registry, ChiCTR2000041016. Registered 16 December 2020-Retrospectively registered, http://www.chictr.org.cn/listbycreater.aspx .
我们使用前后位（AP）髋关节X线片测量了多个指标，以研究与全髋关节置换术（THA）前骨密度（BMD）的相关性，并发现了一个预测股骨骨密度的高效指标。该技术有助于患者和临床医生识别骨密度低的潜在候选者，对于这些人特别推荐进行双能X线吸收法（DXA）检查。
本研究的目的是借助AP髋关节X线片识别全髋关节置换术前骨密度低的患者。
在患者进行THA之前，获取其AP髋关节X线片上的指标以及腰椎和患侧髋关节DXA检查的T值。在AP髋关节X线片上测量的指标包括髓腔距比率（CCR）、髓腔扩张指数（CFI）、形态皮质指数（MCI）、髓腔骨比率（CBR）和髓腔骨面积比率（CBAR）。通过相关性分析评估指标与股骨T值之间的相关性，并通过受试者工作特征（ROC）曲线检查指标对骨质减少的诊断价值。
共纳入81例患者。CBR-7、CBR-10和CBAR（7-10）的平均值与股骨T值高度相关（分别为r = -0.592、r = -0.634和r = -0.631，p < 0.0001）。观察者内和观察者间变异评估结果良好。非骨质减少组和骨质减少组之间的CBR-7、CBR-10和CBAR（7-10）存在显著差异（p < 0.0001）。CBR-10的曲线下面积（AUC）最大，意味着对股骨近端骨质减少具有较大的诊断价值（AUC = 0.821，截断值 = 0.3805）。
小转子水平下10×10 m处的髓腔骨比率被证明是股骨骨质减少的一个重要指标。试验注册 中国临床试验注册中心，ChiCTR2000041016。2020年12月16日注册——回顾性注册，http://www.chictr.org.cn/listbycreater.aspx 。
