Pontificia Universidad Católica de Chile, Santiago, Chile; Hospital Clínico UC-Christus, Santiago, Chile.
J Arthroplasty. 2024 Feb;39(2):427-432. doi: 10.1016/j.arth.2023.08.037. Epub 2023 Aug 18.
Osteoporosis increases the risk of periprosthetic fracture and loosening in hip arthroplasty. Many methods have been proposed to assess bone quality in X-rays, including both qualitative such as the Dorr classification and quantitative such as the Calcar-Canal Ratio (CCR) and Cortical-Thickness index/Canal-Bone ratio (CTI/CBR). The Canal-Diaphysis ratio (CDR) has been described as a predictor for hip fragility fractures; however, its relationship with bone mineral density (BMD) has not been described. The purpose of this study was to evaluate the correlation of the Dorr classification, CCR, CTI/CBR, and CDR with BMD of the proximal femur in patients without hip fracture.
Forty-seven patients over 45 years of age who had less than 6 months between radiographs and dual-energy X-ray absorptiometry were evaluated. Measurements of CCR, CBR, CDR, and Dorr classification were performed in all radiographs by 2 independent observers.
The CDR had a high correlation (r = 0.74, P=<0.01) with BMD, whereas the CTI/CBR had a moderate correlation (r = 0.49, P=<0.01), and the CCR had no correlation with BMD (r = 0.06, P = .96). When evaluating the receiver operating characteristic curve, CDR showed the best performance (area under curve [AUC] = 0.75) followed by CBR (AUC = 0.73) and CCR (AUC = 0.61). The optimal cutoff value for the CDR was 0.49, with 100% sensitivity and 58% specificity. The inter- and intra-observer variability was good for all methods. No differences were found between Dorr classification of patients who had or did not have osteoporosis.
Of all the analyzed methods, the CDR was found to have the best correlation with BMD. This study proposes the use of CDR as a tool for assessing bone quality when deciding the implant fixation method in hip arthroplasty.
骨质疏松症会增加髋关节置换术后假体周围骨折和松动的风险。已经提出了许多方法来评估 X 光中的骨质量，包括定性的方法，如 Dorr 分类，以及定量的方法，如 Calcar-Canal Ratio（CCR）和 Cortical-Thickness index/Canal-Bone ratio（CTI/CBR）。Canal-Diaphysis ratio（CDR）已被描述为髋部脆性骨折的预测因子；然而，其与骨密度（BMD）的关系尚未描述。本研究旨在评估 Dorr 分类、CCR、CTI/CBR 和 CDR 与无髋部骨折患者股骨近端 BMD 的相关性。
评估了 47 名年龄超过 45 岁且 X 光片和双能 X 射线吸收法之间的时间间隔少于 6 个月的患者。由 2 名独立观察者在所有 X 光片中测量 CCR、CBR、CDR 和 Dorr 分类。
CDR 与 BMD 高度相关（r=0.74，P<0.01），而 CTI/CBR 中度相关（r=0.49，P<0.01），CCR 与 BMD 不相关（r=0.06，P=0.96）。在评估受试者工作特征曲线时，CDR 表现最佳（曲线下面积[AUC]=0.75），其次是 CBR（AUC=0.73）和 CCR（AUC=0.61）。CDR 的最佳截断值为 0.49，灵敏度为 100%，特异性为 58%。所有方法的观察者内和观察者间变异性均良好。在患有或不患有骨质疏松症的患者中，Dorr 分类之间没有差异。
在所分析的方法中，CDR 与 BMD 的相关性最好。本研究提出使用 CDR 作为髋关节置换术决定植入物固定方法时评估骨质量的工具。
