Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yi Shan Road, Shanghai 200233, China.
Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600, Yi Shan Road, Shanghai 200233, China.
Acad Radiol. 2023 Jul;30(7):1367-1373. doi: 10.1016/j.acra.2022.09.014. Epub 2022 Oct 15.
To investigate the relationship between upper-thigh intermuscular fat, subcutaneous fat measured by CT and major complications after primary total hip arthroplasty (THA).
Between 2015 and 2021, consecutive patients who had primary THA and preoperative hip CT were retrospectively included. Upper-thigh muscle cross-sectional intermuscular fat, subcutaneous fat, and muscle area were measured on hip CT images. The major complications included dislocation, aseptic loosening, infection, and periprosthetic fracture. The effect of upper-thigh intermuscular fat, subcutaneous fat and muscle area on the outcome was analyzed using multivariable cox proportional hazards analysis. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated.
A total of 3028 patients were included and 71 (2.34%) of them had major complications. During a median of 25 months of follow-up, patients showed increased incidence of total major complications with increased intermuscular fat area (log-rank p = 0.012). The multivariable cox regression revealed that per SD increment in intermuscular fat area was associated with higher risk of total major complications (HR = 2.04, 95% CI = 1.71-2.43, p < 0.001), dislocation (HR = 1.96, 95% CI = 1.44-2.66, p < 0.001), aseptic loosening (HR = 2.02, 95% CI = 1.30-3.16, p = 0.002), infection (HR = 1.94, 95% CI = 1.24-3.05, p = 0.004), and periprosthetic fracture (HR = 2.26, 95% CI = 1.67-3.07, p < 0.001).
Upper-thigh intermuscular fat, but not subcutaneous fat measured on CT associated with the risk of major complications after primary THA.
本研究旨在探讨 CT 测量的大腿上部肌间脂肪与初次全髋关节置换术后（THA）主要并发症之间的关系。
回顾性纳入 2015 年至 2021 年期间行初次 THA 且术前行髋关节 CT 的连续患者。在髋关节 CT 图像上测量大腿上部肌肉横截面积的肌间脂肪、皮下脂肪和肌肉面积。主要并发症包括脱位、无菌性松动、感染和假体周围骨折。使用多变量 Cox 比例风险分析来分析大腿上部肌间脂肪、皮下脂肪和肌肉面积对结果的影响。计算调整后的风险比（HR）和 95%置信区间（CI）。
共纳入 3028 例患者，其中 71 例（2.34%）发生主要并发症。在中位数为 25 个月的随访期间，随着肌间脂肪面积的增加，患者总主要并发症的发生率增加（对数秩检验，p=0.012）。多变量 Cox 回归显示，肌间脂肪面积每增加 1 个标准差，总主要并发症的风险增加（HR=2.04，95%CI=1.71-2.43，p<0.001），包括脱位（HR=1.96，95%CI=1.44-2.66，p<0.001）、无菌性松动（HR=2.02，95%CI=1.30-3.16，p=0.002）、感染（HR=1.94，95%CI=1.24-3.05，p=0.004）和假体周围骨折（HR=2.26，95%CI=1.67-3.07，p<0.001）。
CT 测量的大腿上部肌间脂肪与初次 THA 后主要并发症的风险相关，而不是皮下脂肪。
