Kharbat Abdurrahman F, Cox Cameron T, Martinez Jarrod M, MacKay Brendan J
Neurological Surgery, Texas Tech University Health Sciences Center, Amarillo, USA.
Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, USA.
Cureus. 2023 Mar 9;15(3):e35957. doi: 10.7759/cureus.35957. eCollection 2023 Mar.
Objective Injuries resulting from trauma or tumor resection may cause length alterations in the bones of the upper extremities (UE) requiring reconstruction. Direct contralateral bone is often used to determine the appropriate length for reconstruction but fails to account for potential asymmetry. Given the paucity of data assessing asymmetry in living populations and the need for accurate length approximation, we developed a study evaluating UE long bone asymmetry using radiographic imaging in living subjects. Methods Bilateral X-ray images previously obtained for traumatic injury or chronic osseous conditions were retrospectively collected for adult subjects (ages 18-81). After screening, 61 patients met the inclusion criteria: 28 radii, 29 ulnae, and 19 humeri. Three serial measurements were taken, and the median was used for subsequent analysis. Wilcoxon signed-rank tests were performed to assess differences in contralateral bone lengths. Bootstrapping was utilized to obtain sample sizes of 200, 500, and 1000 for each bone. Results The difference in mean absolute length was 27.0 mm for the humerus, 8.6 mm for the radius, and 7.5 mm for the ulna. Neither the left side nor the right side was significantly longer for any bone. In 57.9% (11/19) of patients, the right humerus was longer than the left; in 60.7% (17/28), the right radius was longer than the left; and in 48.3% (14/29), the right ulna was longer than the left. All other measurements showed the left was longer than the right. Wilcoxon signed-rank tests did not find significant differences between contralateral pairs in any direct measurement group. In bootstrap samples, significant differences in length (p ≤ 0.05) were seen in all samples (n = 200, 500, and 1000) for both humerus and radius but only the 1000 sample group for the ulna. Conclusions Direct contralateral measure may be an appropriate method of length estimation for the humerus, radius, and ulna in post-industrial humans.
目的 创伤或肿瘤切除导致的损伤可能会引起上肢骨骼长度改变，需要进行重建。通常使用对侧骨骼直接测量来确定合适的重建长度，但未考虑到潜在的不对称性。鉴于评估活体人群不对称性的数据匮乏以及准确估计长度的需求，我们开展了一项利用影像学对活体受试者上肢长骨不对称性进行评估的研究。方法 回顾性收集成年受试者（年龄18 - 81岁）之前因创伤性损伤或慢性骨病而获得的双侧X线图像。经过筛选，61例患者符合纳入标准：28例桡骨、29例尺骨和19例肱骨。进行了三次连续测量，并将中位数用于后续分析。采用Wilcoxon符号秩检验评估对侧骨骼长度差异。利用自抽样法分别获取每组骨骼样本量为200、500和1000的样本。结果 肱骨平均绝对长度差异为27.0毫米，桡骨为8.6毫米，尺骨为7.5毫米。任何骨骼的左侧或右侧均无明显更长情况。在57.9%（11/19）的患者中，右侧肱骨比左侧长；在60.7%（17/28）的患者中，右侧桡骨比左侧长；在48.3%（14/29）的患者中，右侧尺骨比左侧长。所有其他测量显示左侧比右侧长。Wilcoxon符号秩检验在任何直接测量组中均未发现对侧配对之间存在显著差异。在自抽样样本中，肱骨和桡骨的所有样本量（n = 200、500和1000）均出现了长度的显著差异（p≤0.05），但尺骨仅在样本量为1000的样本组中出现显著差异。结论 对于工业化后的人类而言，对侧直接测量可能是估计肱骨、桡骨和尺骨长度的合适方法。
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