Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada.
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
J Bone Joint Surg Am. 2024 Jun 5;106(11):950-957. doi: 10.2106/JBJS.23.01177. Epub 2024 Apr 10.
Sarcopenia is associated with falls, fractures, postoperative complications such as periprosthetic joint infections and dislocations, and early mortality. Although cross-sectional imaging is currently used to diagnose sarcopenia, inexpensive and widely available screening tests are needed. The goal of this study was to investigate whether measurements of thigh muscles made on radiographs can predict psoas muscle area and the presence of sarcopenia as determined on computed tomography (CT) scans.
A retrospective radiographic review was performed to measure thigh muscle area in the coronal and sagittal planes using the differential in soft-tissue attenuation. Psoas muscle area on CT at L3 and L4 served as the gold standard for the diagnosis of sarcopenia. The correlation between thigh muscle and psoas muscle areas was determined, and multivariable models were developed to identify predictors of psoas muscle area and sarcopenia.
Four hundred and fourteen patients (252 male, 162 female) were identified. Seventy-six (18.4%) of the patients had an L4 psoas muscle area below the sex-specific cutoff value for sarcopenia. Patients with sarcopenia on abdominal CT had significantly smaller thigh muscle measurements on all radiographic views. The mean and standard deviation of the thigh muscle measurements were determined for the entire cohort and for patients with sarcopenia, as well as for adults aged 18 to 40 years without sarcopenia to provide normative reference values. The intraclass correlation coefficients were >0.8 for all radiographic measurements. The anteroposterior-view measurement of thigh muscle width and lateral-view measurement of quadriceps height were identified as independent predictors of both psoas muscle area and sarcopenia.
Measurements of thigh muscle size made on radiographs can predict both psoas muscle area and sarcopenia. These measurements are a reliable and readily available screening tool to aid in the diagnosis and treatment of sarcopenia in the orthopaedic population.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
肌少症与跌倒、骨折、术后并发症（如假体周围关节感染和脱位）以及早期死亡有关。尽管目前使用横断面成像来诊断肌少症，但需要廉价且广泛可用的筛查测试。本研究的目的是探讨在 X 线片上测量大腿肌肉是否可以预测腰椎 3 （L3）和腰椎 4 （L4）层面的竖脊肌面积以及计算机断层扫描（CT）上的肌少症的存在。
对 X 线片进行回顾性放射学评估，使用软组织衰减差异测量冠状面和矢状面的大腿肌肉面积。L3 和 L4 的竖脊肌面积作为 CT 诊断肌少症的金标准。确定了大腿肌肉和竖脊肌面积之间的相关性，并建立了多变量模型以确定竖脊肌面积和肌少症的预测因素。
共确定了 414 名患者（252 名男性，162 名女性）。76 名患者（18.4%）的 L4 竖脊肌面积低于肌少症的性别特异性截断值。CT 上存在腹部肌少症的患者在所有 X 线片上的大腿肌肉测量值均显著较小。确定了整个队列和存在肌少症的患者的大腿肌肉测量值的平均值和标准差，以及年龄在 18 至 40 岁之间且无肌少症的成年人的大腿肌肉测量值，以提供正常参考值。所有放射学测量的组内相关系数均＞0.8。股骨干前后径宽度测量值和股四头肌高度的外侧径测量值被确定为竖脊肌面积和肌少症的独立预测因素。
X 线片上大腿肌肉大小的测量可以预测竖脊肌面积和肌少症。这些测量值是一种可靠且易于获得的筛查工具，可用于帮助诊断和治疗骨科人群中的肌少症。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
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